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Plumb ID, Briggs Hagen M, Wiegand R, Dumyati G, Myers C, Harland KK, Krishnadasan A, James Gist J, Abedi G, Fleming-Dutra KE, Chea N, Lee JE, Kellogg M, Edmundson A, Britton A, Wilson LE, Lovett SA, Ocampo V, Markus TM, Smithline HA, Hou PC, Lee LC, Mower W, Rwamwejo F, Steele MT, Lim SC, Schrading WA, Chinnock B, Beiser DG, Faine B, Haran JP, Nandi U, Chipman AK, LoVecchio F, Eucker S, Femling J, Fuller M, Rothman RE, Curlin ME, Talan DA, Mohr NM. Effectiveness of a bivalent mRNA vaccine dose against symptomatic SARS-CoV-2 infection among U.S. Healthcare personnel, September 2022-May 2023. Vaccine 2024; 42:2543-2552. [PMID: 37973512 PMCID: PMC10994739 DOI: 10.1016/j.vaccine.2023.10.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Bivalent mRNA vaccines were recommended since September 2022. However, coverage with a recent vaccine dose has been limited, and there are few robust estimates of bivalent VE against symptomatic SARS-CoV-2 infection (COVID-19). We estimated VE of a bivalent mRNA vaccine dose against COVID-19 among eligible U.S. healthcare personnel who had previously received monovalent mRNA vaccine doses. METHODS We conducted a case-control study in 22 U.S. states, and enrolled healthcare personnel with COVID-19 (case-participants) or without COVID-19 (control-participants) during September 2022-May 2023. Participants were considered eligible for a bivalent mRNA dose if they had received 2-4 monovalent (ancestral-strain) mRNA vaccine doses, and were ≥67 days after the most recent vaccine dose. We estimated VE of a bivalent mRNA dose using conditional logistic regression, accounting for matching by region and four-week calendar period. We adjusted estimates for age group, sex, race and ethnicity, educational level, underlying health conditions, community COVID-19 exposure, prior SARS-CoV-2 infection, and days since the last monovalent mRNA dose. RESULTS Among 3,647 healthcare personnel, 1,528 were included as case-participants and 2,119 as control-participants. Participants received their last monovalent mRNA dose a median of 404 days previously; 1,234 (33.8%) also received a bivalent mRNA dose a median of 93 days previously. Overall, VE of a bivalent dose was 34.1% (95% CI, 22.6%-43.9%) against COVID-19 and was similar by product, days since last monovalent dose, number of prior doses, age group, and presence of underlying health conditions. However, VE declined from 54.8% (95% CI, 40.7%-65.6%) after 7-59 days to 21.6% (95% CI 5.6%-34.9%) after ≥60 days. CONCLUSIONS Bivalent mRNA COVID-19 vaccines initially conferred approximately 55% protection against COVID-19 among U.S. healthcare personnel. However, protection waned after two months. These findings indicate moderate initial protection against symptomatic SARS-CoV-2 infection by remaining up-to-date with COVID-19 vaccines.
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Affiliation(s)
- Ian D Plumb
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Ryan Wiegand
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | - Jade James Gist
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Glen Abedi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Katherine E Fleming-Dutra
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Nora Chea
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control & Prevention, USA
| | - Jane E Lee
- California Emerging Infections Program, Oakland, CA, USA
| | | | - Alexandra Edmundson
- Connecticut Emerging Infections Program, Yale School of Public Health, CT, USA
| | - Amber Britton
- Georgia Emerging Infections Program and Emory University School of Medicine, Atlanta, GA, USA
| | - Lucy E Wilson
- Maryland Emerging Infections Program, Maryland Department of Health and University of Maryland, Baltimore, MD, USA
| | | | - Valerie Ocampo
- Public Health Division, Oregon Health Authority, OR, USA
| | | | | | - Peter C Hou
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Mark T Steele
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Stephen C Lim
- University Medical Center New Orleans, LSU Health Sciences Center, New Orleans, LA, USA
| | | | | | | | | | - John P Haran
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Utsav Nandi
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | | | - Jon Femling
- University of New Mexico Health Science Center, USA
| | | | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
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2
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Borst B, Jovanovic T, House SL, Bruce SE, Harnett NG, Roeckner AR, Ely TD, Lebois LAM, Young D, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Harte SE, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Stevens JS, van Rooij SJH. Sex differences in response inhibition-related neural predictors of PTSD in recent trauma-exposed civilians. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00080-6. [PMID: 38522649 DOI: 10.1016/j.bpsc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Females are more likely to develop posttraumatic stress disorder (PTSD) than males. Impaired inhibition has been identified as mechanism for PTSD development, but studies on the potential sex differences of this neurobiological mechanism and how it relates to PTSD severity and progression are sparse. Here we examined sex differences in neural activation during response inhibition and PTSD following recent trauma. METHODS Participants (N= 205, 138 female sex assigned at birth) were recruited from emergency departments within 72 hours of a traumatic event. PTSD symptoms were assessed 2-weeks and 6-months post-trauma. A Go/NoGo task was performed 2-weeks post-trauma in a 3T MRI scanner to measure neural activity during response inhibition in the ventromedial prefrontal cortex (vmPFC), right inferior frontal gyrus (rIFG), and the bilateral hippocampus. General Linear models were used to examine the interaction effect of sex on the relationship between our regions of interest (ROIs) and the whole brain, and PTSD symptoms at 6-months, and symptom progression between 2-weeks and 6-months. RESULTS Lower response-inhibition-related vmPFC activation 2-weeks post-trauma predicted more PTSD symptoms at 6-months in females but not in males, while greater response-inhibition-related rIFG activation predicted lower PTSD symptom progression in males but not females. Whole brain interaction effects were observed in the medial temporal gyrus and left precentral gyrus. CONCLUSIONS There are sex differences in the relationship between inhibition-related brain activation and PTSD symptom severity and progression. These findings suggest that sex differences should be assessed in future PTSD studies and reveal potential targets for sex-specific interventions.
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Affiliation(s)
- Bibian Borst
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alyssa R Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Dmitri Young
- University of California San Francisco, San Francisco, CA, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA; Department of Emergency Medicine, Brown University, Providence, RI
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; The Many Brains Project, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Ohio State University College of Nursing, Columbus, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Jefferson Einstein hospital, Jefferson Health, Philadelphia, PA, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Garrison-Desany HM, Meyers JL, Linnstaedt SD, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Bruce SE, Joormann J, Harte SE, McLean SA, Koenen KC, Denckla CA. Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk. Front Psychiatry 2024; 15:1249382. [PMID: 38525258 PMCID: PMC10957776 DOI: 10.3389/fpsyt.2024.1249382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024] Open
Abstract
Background Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. Methods The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. Results At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. Conclusion PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.
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Affiliation(s)
- Henri M. Garrison-Desany
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jacquelyn L. Meyers
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, New York City, NY, United States
| | - Sarah D. Linnstaedt
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Xinming An
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- The Many Brains Project, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Nina T. Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jose L. Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, United States
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Robert M. Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, United States
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, United States
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center, Houston, TX, United States
| | - Leon D. Sanchez
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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4
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Hinojosa CA, Liew A, An X, Stevens JS, Basu A, van Rooij SJH, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Fani N. Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals. Psychol Med 2024; 54:338-349. [PMID: 37309917 PMCID: PMC10716364 DOI: 10.1017/s0033291723001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. METHODS In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. RESULTS Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. CONCLUSIONS Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
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Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda Liew
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sanne J H. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - John F. Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M. Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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5
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Wong SA, Lebois LAM, Ely TD, van Rooij SJH, Bruce SE, Murty VP, Jovanovic T, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Stevens JS, Harnett NG. Internal capsule microstructure mediates the relationship between childhood maltreatment and PTSD following adulthood trauma exposure. Mol Psychiatry 2023; 28:5140-5149. [PMID: 36932158 PMCID: PMC10505244 DOI: 10.1038/s41380-023-02012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
Childhood trauma is a known risk factor for trauma and stress-related disorders in adulthood. However, limited research has investigated the impact of childhood trauma on brain structure linked to later posttraumatic dysfunction. We investigated the effect of childhood trauma on white matter microstructure after recent trauma and its relationship with future posttraumatic dysfunction among trauma-exposed adult participants (n = 202) recruited from emergency departments as part of the AURORA Study. Participants completed self-report scales assessing prior childhood maltreatment within 2-weeks in addition to assessments of PTSD, depression, anxiety, and dissociation symptoms within 6-months of their traumatic event. Fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI) collected at 2-weeks and 6-months was used to index white matter microstructure. Childhood maltreatment load predicted 6-month PTSD symptoms (b = 1.75, SE = 0.78, 95% CI = [0.20, 3.29]) and inversely varied with FA in the bilateral internal capsule (IC) at 2-weeks (p = 0.0294, FDR corrected) and 6-months (p = 0.0238, FDR corrected). We observed a significant indirect effect of childhood maltreatment load on 6-month PTSD symptoms through 2-week IC microstructure (b = 0.37, Boot SE = 0.18, 95% CI = [0.05, 0.76]) that fully mediated the effect of childhood maltreatment load on PCL-5 scores (b = 1.37, SE = 0.79, 95% CI = [-0.18, 2.93]). IC microstructure did not mediate relationships between childhood maltreatment and depressive, anxiety, or dissociative symptomatology. Our findings suggest a unique role for IC microstructure as a stable neural pathway between childhood trauma and future PTSD symptoms following recent trauma. Notably, our work did not support roles of white matter tracts previously found to vary with PTSD symptoms and childhood trauma exposure, including the cingulum bundle, uncinate fasciculus, and corpus callosum. Given the IC contains sensory fibers linked to perception and motor control, childhood maltreatment might impact the neural circuits that relay and process threat-related inputs and responses to trauma.
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Affiliation(s)
- Samantha A Wong
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, Camperdown, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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6
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Zeamer AL, Salive MC, An X, Beaudoin FL, House SL, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Rauch SL, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Kessler RC, Koenen KC, McLean SA, Bucci V, Haran JP. Association between microbiome and the development of adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure. Transl Psychiatry 2023; 13:354. [PMID: 37980332 PMCID: PMC10657470 DOI: 10.1038/s41398-023-02643-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biological mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition after trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether the gut microbiomes of trauma-exposed emergency department patients who develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms. We performed metagenomic analysis on stool samples (n = 51) from a subset of adults enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA) study. Two-, eight- and twelve-week post-trauma outcomes for post-traumatic stress disorder (PTSD) (PTSD checklist for DSM-5), normalized depression scores (PROMIS Depression Short Form 8b) and somatic symptom counts were collected. Generalized linear models were created for each outcome using microbial abundances and relevant demographics. Mixed-effect random forest machine learning models were used to identify associations between APNS outcomes and microbial features and encoded metabolic pathways from stool metagenomics. Microbial species, including Flavonifractor plautii, Ruminococcus gnavus and, Bifidobacterium species, which are prevalent commensal gut microbes, were found to be important in predicting worse APNS outcomes from microbial abundance data. Notably, through APNS outcome modeling using microbial metabolic pathways, worse APNS outcomes were highly predicted by decreased L-arginine related pathway genes and increased citrulline and ornithine pathways. Common commensal microbial species are enriched in individuals who develop APNS. More notably, we identified a biological mechanism through which the gut microbiome reduces global arginine bioavailability, a metabolic change that has also been demonstrated in the plasma of patients with PTSD.
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Affiliation(s)
- Abigail L Zeamer
- Department of Microbiology and Physiologic Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Marie-Claire Salive
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Xinming An
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vanni Bucci
- Department of Microbiology and Physiologic Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Program in Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - John P Haran
- Department of Microbiology and Physiologic Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Program in Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, MA, USA.
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7
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Plumb ID, Mohr NM, Hagen M, Wiegand R, Dumyati G, Harland KK, Krishnadasan A, Gist JJ, Abedi G, Fleming-Dutra KE, Chea N, Lee J, Barter D, Brackney M, Fridkin SK, Wilson LE, Lovett SA, Ocampo V, Phipps EC, Marcus TM, Smithline HA, Hou PC, Lee LC, Moran GJ, Krebs E, Steele MT, Lim SC, Schrading WA, Chinnock B, Beiser DG, Faine B, Haran JP, Nandi U, Chipman AK, LoVecchio F, Talan DA, Pilishvili T. Effectiveness of a Messenger RNA Vaccine Booster Dose Against Coronavirus Disease 2019 Among US Healthcare Personnel, October 2021-July 2022. Open Forum Infect Dis 2023; 10:ofad457. [PMID: 37799130 PMCID: PMC10549208 DOI: 10.1093/ofid/ofad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Background Protection against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]) can limit transmission and the risk of post-COVID conditions, and is particularly important among healthcare personnel. However, lower vaccine effectiveness (VE) has been reported since predominance of the Omicron SARS-CoV-2 variant. Methods We evaluated the VE of a monovalent messenger RNA (mRNA) booster dose against COVID-19 from October 2021 to June 2022 among US healthcare personnel. After matching case-participants with COVID-19 to control-participants by 2-week period and site, we used conditional logistic regression to estimate the VE of a booster dose compared with completing only 2 mRNA doses >150 days previously, adjusted for multiple covariates. Results Among 3279 case-participants and 3998 control-participants who had completed 2 mRNA doses, we estimated that the VE of a booster dose against COVID-19 declined from 86% (95% confidence interval, 81%-90%) during Delta predominance to 65% (58%-70%) during Omicron predominance. During Omicron predominance, VE declined from 73% (95% confidence interval, 67%-79%) 14-60 days after the booster dose, to 32% (4%-52%) ≥120 days after a booster dose. We found that VE was similar by age group, presence of underlying health conditions, and pregnancy status on the test date, as well as among immunocompromised participants. Conclusions A booster dose conferred substantial protection against COVID-19 among healthcare personnel. However, VE was lower during Omicron predominance, and waning effectiveness was observed 4 months after booster dose receipt during this period. Our findings support recommendations to stay up to date on recommended doses of COVID-19 vaccines for all those eligible.
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Affiliation(s)
- Ian D Plumb
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Melissa Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan Wiegand
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ghinwa Dumyati
- New York State Emerging Infections Program, University of Rochester Medical Center, Rochester, New York, USA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Anusha Krishnadasan
- Department of Emergency Medicine, Olive View–UCLA Education and Research Institute, Los Angeles, California, USA
| | - Jade James Gist
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Glen Abedi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Fleming-Dutra
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nora Chea
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jane Lee
- Healthcare-Associated Infections, California Emerging Infections Program, Oakland, California, USA
| | - Devra Barter
- Healthcare-associated Infections / Antimicrobial Resistance Program, Colorado Department of Public Health & Environment, Denver, Colorado, USA
| | - Monica Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Scott K Fridkin
- Georgia Emerging Infections Program and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lucy E Wilson
- Maryland Emerging Infections Program, Maryland Department of Health, and University of Maryland,Baltimore County, Baltimore, Maryland, USA
| | - Sara A Lovett
- Infectious Disease Epidemiology, Prevention and Control Divison, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Valerie Ocampo
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Tiffanie M Marcus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Howard A Smithline
- Department of Emergency Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
| | - Peter C Hou
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lilly C Lee
- Emergency Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Gregory J Moran
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Elizabeth Krebs
- Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark T Steele
- Department of Emergency Medicine, University of Missouri–Kansas City, Kansas City, Missouri, USA
| | - Stephen C Lim
- Section of Emergency Medicine, University Medical Center New Orleans, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Walter A Schrading
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brian Chinnock
- Department of Emergency Medicine, University of California San Francisco, Fresno, California, USA
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
| | - Brett Faine
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Utsav Nandi
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anne K Chipman
- Emergency Department, University of Washington, Seattle, Washington, USA
| | - Frank LoVecchio
- Emergency Medicine, Valleywise Health Medical Center, Phoenix, Arizona, USA
| | - David A Talan
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Tamara Pilishvili
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Rowland GE, Roeckner A, Ely TD, Lebois LAM, van Rooij SJH, Bruce SE, Jovanovic T, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Stevens JS, Harnett NG. Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study. Biol Psychiatry Glob Open Sci 2023; 3:705-715. [PMID: 37881578 PMCID: PMC10593890 DOI: 10.1016/j.bpsgos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Background Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST. Methods Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST. Results Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10-7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10-5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10-4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: -4.41, corrected p < .02). Conclusions Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.
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Affiliation(s)
- Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Alyssa Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, Missouri
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- TheMany Brains Project, Belmont, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio
- Ohio State University College of Nursing, Columbus, Ohio
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Harris
- Einstein Medical Center, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, Ohio
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, Ohio
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James M Elliott
- Kolling Institute, University of Sydney, St. Leonards, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Sydney, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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9
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Xia Y, Xiao Y, Wang ZH, Liu X, Alam AM, Haran JP, McCormick BA, Shu X, Wang X, Ye K. Bacteroides Fragilis in the gut microbiomes of Alzheimer's disease activates microglia and triggers pathogenesis in neuronal C/EBPβ transgenic mice. Nat Commun 2023; 14:5471. [PMID: 37673907 PMCID: PMC10482867 DOI: 10.1038/s41467-023-41283-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
Gut dysbiosis contributes to Alzheimer's disease (AD) pathogenesis, and Bacteroides strains are selectively elevated in AD gut microbiota. However, it remains unknown which Bacteroides species and how their metabolites trigger AD pathologies. Here we show that Bacteroides fragilis and their metabolites 12-hydroxy-heptadecatrienoic acid (12-HHTrE) and Prostaglandin E2 (PGE2) activate microglia and induce AD pathogenesis in neuronal C/EBPβ transgenic mice. Recolonization of antibiotics cocktail-pretreated Thy1-C/EBPβ transgenic mice with AD patient fecal samples elicits AD pathologies, associated with C/EBPβ/Asparaginyl endopeptidase (AEP) pathway upregulation, microglia activation, and cognitive disorders compared to mice receiving healthy donors' fecal microbiota transplantation (FMT). Microbial 16S rRNA sequencing analysis shows higher abundance of proinflammatory Bacteroides fragilis in AD-FMT mice. Active components characterization from the sera and brains of the transplanted mice revealed that both 12-HHTrE and PGE2 activate primary microglia, fitting with poly-unsaturated fatty acid (PUFA) metabolites enrichment identified by metabolomics. Strikingly, recolonization with live but not dead Bacteroides fragilis elicited AD pathologies in Thy1-C/EBPβ transgenic mice, so did 12-HHTrE or PGE2 treatment alone. Collectively, our findings support a causal role for Bacteroides fragilis and the PUFA metabolites in activating microglia and inducing AD pathologies in Thy1- C/EBPβ transgenic mice.
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Affiliation(s)
- Yiyuan Xia
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- School of Medicine, Jianghan University, Wuhan, HB, 430056, China
| | - Yifan Xiao
- School of Medicine, Jianghan University, Wuhan, HB, 430056, China
| | - Zhi-Hao Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Xia Liu
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ashfaqul M Alam
- University of Kentucky, Microbiology, Immunology & Molecular Genetics Office - MN 376, Medical Science Building, 800 Rose Street, Lexington, KY, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Program in Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Beth A McCormick
- Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Program in Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Xiji Shu
- School of Medicine, Jianghan University, Wuhan, HB, 430056, China.
| | - Xiaochuan Wang
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China/Hubei Province for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Co-innovation Center of Neurodegeneration, Nantong University, Nantong, Jiangsu, China.
| | - Keqiang Ye
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology, Shenzhen, Guangdong, 518055, China.
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10
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Webb EK, Ely TD, Rowland GE, Lebois LAM, van Rooij SJH, Bruce SE, Jovanovic T, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Kessler RC, Koenen KC, McLean SA, Stevens JS, Ressler KJ, Harnett NG. Neighborhood Disadvantage and Neural Correlates of Threat and Reward Processing in Survivors of Recent Trauma. JAMA Netw Open 2023; 6:e2334483. [PMID: 37721751 PMCID: PMC10507487 DOI: 10.1001/jamanetworkopen.2023.34483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Importance Differences in neighborhood socioeconomic characteristics are important considerations in understanding differences in risk vs resilience in mental health. Neighborhood disadvantage is associated with alterations in the function and structure of threat neurocircuitry. Objective To investigate associations of neighborhood disadvantage with white and gray matter and neural reactivity to positive and negative stimuli in the context of trauma exposure. Design, Setting, and Participants In this cross-sectional study, survivors of trauma who completed sociodemographic and posttraumatic symptom assessments and neuroimaging were recruited as part of the Advancing Understanding of Recovery After Trauma (AURORA) study between September 2017 and June 2021. Data analysis was performed from October 25, 2022, to February 15, 2023. Exposure Neighborhood disadvantage was measured with the Area Deprivation Index (ADI) for each participant home address. Main Outcomes and Measures Participants completed separate threat and reward tasks during functional magnetic resonance imaging. Diffusion-weighted and high-resolution structural images were also collected. Linear models assessed the association of ADI with reactivity, microstructure, and macrostructure of a priori regions of interest after adjusting for income, lifetime trauma, sex at birth, and age. A moderated-mediation model tested whether ADI was associated with neural activity via microstructural changes and if this was modulated by PTSD symptoms. Results A total of 280 participants (183 females [65.4%]; mean [SD] age, 35.39 [13.29] years) completed the threat task and 244 participants (156 females [63.9%]; mean [SD] age, 35.10 [13.26] years) completed the reward task. Higher ADI (per 1-unit increase) was associated with greater insula (t274 = 3.20; β = 0.20; corrected P = .008) and anterior cingulate cortex (ACC; t274 = 2.56; β = 0.16; corrected P = .04) threat-related activity after considering covariates, but ADI was not associated with reward reactivity. Greater disadvantage was also associated with altered microstructure of the cingulum bundle (t274 = 3.48; β = 0.21; corrected P = .001) and gray matter morphology of the ACC (cortical thickness: t273 = -2.29; β = -0.13; corrected P = .02; surface area: t273 = 2.53; β = 0.13; corrected P = .02). The moderated-mediation model revealed that ADI was associated with ACC threat reactivity via cingulum microstructural changes (index of moderated mediation = -0.02). However, this mediation was only present in individuals with greater PTSD symptom severity (at the mean: β = -0.17; standard error = 0.06, t= -2.28; P = .007; at 1 SD above the mean: β = -0.28; standard error = 0.08; t = -3.35; P < .001). Conclusions and Relevance In this study, neighborhood disadvantage was associated with neurobiology that supports threat processing, revealing associations of neighborhood disadvantage with neural susceptibility for PTSD and suggesting how altered structure-function associations may complicate symptoms. Future work should investigate specific components of neighborhood disadvantage that may be associated with these outcomes.
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Affiliation(s)
- E Kate Webb
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St Louis
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco
- Department Neurology, University of California, San Francisco
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- The Many Brains Project, Belmont, Massachusetts
- Institute for Technology in Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
- Department of Sociology, University of North Carolina at Chapel Hill
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus
- College of Nursing, Ohio State University, Columbus
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jose L Pascual
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, Michigan
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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11
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Harnett NG, Fani N, Carter S, Sanchez LD, Rowland GE, Davie WM, Guzman C, Lebois LAM, Ely TD, van Rooij SJH, Seligowski AV, Winters S, Grasser LR, Musey PI, Seamon MJ, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Hudak LA, Pascual JL, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Jovanovic T, Stevens JS, Ressler KJ. Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure. Mol Psychiatry 2023; 28:2975-2984. [PMID: 36725899 PMCID: PMC10615735 DOI: 10.1038/s41380-023-01971-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study (n = 283), a multisite longitudinal study of trauma outcomes, completed functional magnetic resonance imaging and psychophysiology within approximately two-weeks of trauma exposure. Seed-based amygdala connectivity and amygdala reactivity during passive viewing of fearful and neutral faces were assessed during fMRI. Physiological activity was assessed during Pavlovian threat conditioning. Participants also reported the severity of posttraumatic symptoms 3 and 6 months after trauma. Black individuals showed lower baseline skin conductance levels and startle compared to White individuals, but no differences were observed in physiological reactions to threat. Further, Hispanic and Black participants showed greater amygdala connectivity to regions including the dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, insula, and cerebellum compared to White participants. No differences were observed in amygdala reactivity to threat. Amygdala connectivity was associated with 3-month PTSD symptoms, but the associations differed by racial/ethnic group and were partly driven by group differences in structural inequities. The present findings suggest variability in tonic neurophysiological arousal in the early aftermath of trauma between racial/ethnic groups, driven by structural inequality, impacts neural processes that mediate susceptibility to later PTSD symptoms.
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Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - William M Davie
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Camilo Guzman
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Antonia V Seligowski
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sterling Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Lana R Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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12
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Jones CW, An X, Ji Y, Liu M, Zeng D, House SL, Beaudoin FL, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Punches BE, Lyons MS, Kurz MC, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Koenen KC, Ressler KJ, Kessler RC, McLean SA. Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision. Ann Emerg Med 2023; 81:249-261. [PMID: 36328855 DOI: 10.1016/j.annemergmed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To derive and initially validate a brief bedside clinical decision support tool that identifies emergency department (ED) patients at high risk of substantial, persistent posttraumatic stress symptoms after a motor vehicle collision. METHODS Derivation (n=1,282, 19 ED sites) and validation (n=282, 11 separate ED sites) data were obtained from adults prospectively enrolled in the Advancing Understanding of RecOvery afteR traumA study who were discharged from the ED after motor vehicle collision-related trauma. The primary outcome was substantial posttraumatic stress symptoms at 3 months (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 ≥38). Logistic regression derivation models were evaluated for discriminative ability using the area under the curve and the accuracy of predicted risk probabilities (Brier score). Candidate posttraumatic stress predictors assessed in these models (n=265) spanned a range of sociodemographic, baseline health, peritraumatic, and mechanistic domains. The final model selection was based on performance and ease of administration. RESULTS Significant 3-month posttraumatic stress symptoms were common in the derivation (27%) and validation (26%) cohort. The area under the curve and Brier score of the final 8-question tool were 0.82 and 0.14 in the derivation cohort and 0.76 and 0.17 in the validation cohort. CONCLUSION This simple 8-question tool demonstrates promise to risk-stratify individuals with substantial posttraumatic stress symptoms who are discharged to home after a motor vehicle collision. Both external validation of this instrument, and work to further develop more accurate tools, are needed. Such tools might benefit public health by enabling the conduct of preventive intervention trials and assisting the growing number of EDs that provide services to trauma survivors aimed at promoting psychological recovery.
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Affiliation(s)
- Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Xinming An
- Department of Anesthesiology, Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yinyao Ji
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Mochuan Liu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO
| | - Francesca L Beaudoin
- Department of Emergency Medicine and Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Thomas C Neylan
- Department of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine and Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI
| | - Sarah D Linnstaedt
- Department of Anesthesiology, Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA; The Many Brains Project, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, McLean Hospital, Belmont, MA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Phyllis L Hendry
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL; Department of Emergency Medicine, University of Cincinnati College of Medicine, and College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Brittany E Punches
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL
| | - Michael S Lyons
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Michael C Kurz
- Department of Emergency Medicine, Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, and Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA; Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Mark J Seamon
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, and the Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, MI
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX
| | - Leon D Sanchez
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St Louis, St Louis, MO
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA; Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT
| | | | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA
| | - John F Sheridan
- Department of Biosciences, and the Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, and Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Steven E Harte
- Department of Anesthesiology, and Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, and Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia, and Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Samuel A McLean
- Departments of Emergency Medicine and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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13
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Mohr NM, Plumb ID, Harland KK, Pilishvili T, Fleming-Dutra KE, Krishnadasan A, Hoth KF, Saydah SH, Mankoff Z, Haran JP, Briggs-Hagen M, León ES, Talan DA. Presence of symptoms 6 weeks after COVID-19 among vaccinated and unvaccinated US healthcare personnel: a prospective cohort study. BMJ Open 2023; 13:e063141. [PMID: 36731936 PMCID: PMC9895915 DOI: 10.1136/bmjopen-2022-063141] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Although COVID-19 vaccines offer protection against infection and severe disease, there is limited information on the effect of vaccination on prolonged symptoms following COVID-19. Our objective was to determine differences in prevalence of prolonged symptoms 6 weeks after onset of COVID-19 among healthcare personnel (HCP) by vaccination status, and to assess differences in timing of return to work. DESIGN Cohort analysis of HCP with COVID-19 enrolled in a multicentre vaccine effectiveness study. HCP with COVID-19 between December 2020 and August 2021 were followed up 6 weeks after illness onset. SETTING Health systems in 12 US states. PARTICIPANTS HCP participating in a vaccine effectiveness study were eligible for inclusion if they had laboratory-confirmed symptomatic SARS-CoV-2 with mRNA vaccination (symptom onset ≥14 days after two doses) or no prior vaccination. Among 681 eligible participants, 419 (61%) completed a follow-up survey to assess symptoms reported 6 weeks after illness onset. EXPOSURES Two doses of a COVID-19 mRNA vaccine compared with no COVID-19 vaccine. MAIN OUTCOME MEASURES Prevalence of symptoms 6 weeks after onset of COVID-19 illness and days to return to work. RESULTS Among 419 HCP with COVID-19, 298 (71%) reported one or more COVID-like symptoms 6 weeks after illness onset, with a lower prevalence among vaccinated participants compared with unvaccinated participants (60.6% vs 79.1%; adjusted risk ratio 0.70, 95% CI 0.58 to 0.84). Following their illness, vaccinated HCP returned to work a median 2.0 days (95% CI 1.0 to 3.0) sooner than unvaccinated HCP (adjusted HR 1.37, 95% CI 1.04 to 1.79). CONCLUSIONS Receipt of two doses of a COVID-19 mRNA vaccine among HCP with COVID-19 illness was associated with decreased prevalence of COVID-like symptoms at 6 weeks and earlier return to work.
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Affiliation(s)
- Nicholas M Mohr
- Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, Iowa, USA
- Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ian D Plumb
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kari K Harland
- Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, Iowa, USA
| | - Tamara Pilishvili
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Anusha Krishnadasan
- Olive View and Ronald Reagan-UCLA Medical Center Emergency Medicine, University of California - Los Angeles, Los Angeles, California, USA
| | - Karin F Hoth
- Internal Medicine, University of Iowa Carver College of Medicine, Iowa CIty, Iowa, USA
| | - Sharon H Saydah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary Mankoff
- Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John P Haran
- Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Melissa Briggs-Hagen
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eliezer Santos León
- Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, Iowa, USA
| | - David A Talan
- Olive View and Ronald Reagan-UCLA Medical Center Emergency Medicine, University of California - Los Angeles, Los Angeles, California, USA
- Internal Medicine Division of Infectious Diseases, University of California - Los Angeles, Los Angeles, California, USA
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14
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Beaudoin FL, An X, Basu A, Ji Y, Liu M, Kessler RC, Doughtery RF, Zeng D, Bollen KA, House SL, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Murty VP, McGrath ME, Hudak LA, Pascual JL, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Neil BJO, Sergot P, Sanchez LD, Bruce SE, Baker JT, Joormann J, Miller MW, Pietrzak RH, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Koenen KC, Ressler KJ, McLean SA. Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort. Transl Psychiatry 2023; 13:4. [PMID: 36609484 PMCID: PMC9823011 DOI: 10.1038/s41398-022-02289-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes ( http://itr.med.unc.edu/aurora/parcoord/ ). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.
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Affiliation(s)
- Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mochuan Liu
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O' Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | | | - Jutta Joormann
- Department of Psychology, Yale University, West Haven, CT, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - John F Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local, Health District, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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15
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Short NA, van Rooij SJH, Murty VP, Stevens JS, An X, Ji Y, McLean SA, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, Jovanovic T. Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study. J Psychiatr Res 2022; 156:45-54. [PMID: 36242943 PMCID: PMC10960961 DOI: 10.1016/j.jpsychires.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
Anxiety sensitivity, or fear of anxious arousal, is cross-sectionally associated with a wide array of adverse posttraumatic neuropsychiatric sequelae, including symptoms of posttraumatic stress disorder, depression, anxiety, sleep disturbance, pain, and somatization. The current study utilizes a large-scale, multi-site, prospective study of trauma survivors presenting to emergency departments. Hypotheses tested whether elevated anxiety sensitivity in the immediate posttrauma period is associated with more severe and persistent trajectories of common adverse posttraumatic neuropsychiatric sequelae in the eight weeks posttrauma. Participants from the AURORA study (n = 2,269 recruited from 23 emergency departments) completed self-report assessments over eight weeks posttrauma. Associations between heightened anxiety sensitivity and more severe and/or persistent trajectories of trauma-related symptoms identified by growth mixture modeling were analyzed. Anxiety sensitivity assessed two weeks posttrauma was associated with severe and/or persistent posttraumatic stress, depression, anxiety, sleep disturbance, pain, and somatic symptoms in the eight weeks posttrauma. Effect sizes were in the small to medium range in multivariate models accounting for various demographic, trauma-related, pre-trauma mental health-related, and personality-related factors. Anxiety sensitivity may be a useful transdiagnostic risk factor in the immediate posttraumatic period identifying individuals at risk for the development of adverse posttraumatic neuropsychiatric sequelae. Further, considering anxiety sensitivity is malleable via brief intervention, it could be a useful secondary prevention target. Future research should continue to evaluate associations between anxiety sensitivity and trauma-related pathology.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Psychology, University of Nevada, Las Vegas, NV, 89154, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, 19121, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, The Brown University School of Public Health, Providence, RI, 02930, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; The Many Brains Project, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA; Ohio State University College of Nursing, Columbus, OH, 43210, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, 19141, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, 48202, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA; Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, 2065, Australia; Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, 48202, USA
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16
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Binder RA, Fujimori GF, Forconi CS, Reed GW, Silva LS, Lakshmi PS, Higgins A, Cincotta L, Dutta P, Salive MC, Mangolds V, Anya O, Calvo Calle JM, Nixon T, Tang Q, Wessolossky M, Wang Y, Ritacco DA, Bly CS, Fischinger S, Atyeo C, Oluoch PO, Odwar B, Bailey JA, Maldonado-Contreras A, Haran JP, Schmidt AG, Cavacini L, Alter G, Moormann AM. SARS-CoV-2 Serosurveys: How Antigen, Isotype and Threshold Choices Affect the Outcome. J Infect Dis 2022; 227:371-380. [PMID: 36314635 PMCID: PMC9891417 DOI: 10.1093/infdis/jiac431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Evaluating the performance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays and clearly articulating the utility of selected antigens, isotypes, and thresholds is crucial to understanding the prevalence of infection within selected communities. METHODS This cross-sectional study, implemented in 2020, screened PCRconfirmed coronavirus disease 2019 patients (n 86), banked prepandemic and negative samples (n 96), healthcare workers and family members (n 552), and university employees (n 327) for antiSARS-CoV-2 receptor-binding domain, trimeric spike protein, and nucleocapsid protein immunoglobulin (Ig)G and IgA antibodies with a laboratory-developed enzyme-linked immunosorbent assay and tested how antigen, isotype and threshold choices affected the seroprevalence outcomes. The following threshold methods were evaluated: (i) mean 3 standard deviations of the negative controls; (ii) 100 specificity for each antigen-isotype combination; and (iii) the maximal Youden index. RESULTS We found vastly different seroprevalence estimates depending on selected antigens and isotypes and the applied threshold method, ranging from 0.0 to 85.4. Subsequently, we maximized specificity and reported a seroprevalence, based on more than one antigen, ranging from 9.3 to 25.9. CONCLUSIONS This study revealed the importance of evaluating serosurvey tools for antigen-, isotype-, and threshold-specific sensitivity and specificity, to interpret qualitative serosurvey outcomes reliably and consistently across studies.
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Affiliation(s)
- Raquel A Binder
- Correspondence: Raquel A. Binder, University of Massachusetts Chan Medical School, Worcester, MA 01605 ()
| | | | | | - George W Reed
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leandro S Silva
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Priya Saikumar Lakshmi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amanda Higgins
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lindsey Cincotta
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Marie-Claire Salive
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Virginia Mangolds
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Otuwe Anya
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - J Mauricio Calvo Calle
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Thomas Nixon
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Qiushi Tang
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mireya Wessolossky
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Yang Wang
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Dominic A Ritacco
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Courtney S Bly
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Peter O Oluoch
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Boaz Odwar
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ana Maldonado-Contreras
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA,Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aaron G Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa Cavacini
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
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17
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Bradley ES, Zeamer AL, Bucci V, Cincotta L, Salive MC, Dutta P, Mutaawe S, Anya O, Tocci C, Moormann A, Ward DV, McCormick BA, Haran JP. Oropharyngeal microbiome profiled at admission is predictive of the need for respiratory support among COVID-19 patients. Front Microbiol 2022; 13:1009440. [PMID: 36246273 PMCID: PMC9561819 DOI: 10.3389/fmicb.2022.1009440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
The oropharyngeal microbiome, the collective genomes of the community of microorganisms that colonizes the upper respiratory tract, is thought to influence the clinical course of infection by respiratory viruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Infectious Disease 2019 (COVID-19). In this study, we examined the oropharyngeal microbiome of suspected COVID-19 patients presenting to the Emergency Department and an inpatient COVID-19 unit with symptoms of acute COVID-19. Of 115 initially enrolled patients, 50 had positive molecular testing for COVID-19+ and had symptom duration of 14 days or less. These patients were analyzed further as progression of disease could most likely be attributed to acute COVID-19 and less likely a secondary process. Of these, 38 (76%) went on to require some form of supplemental oxygen support. To identify functional patterns associated with respiratory illness requiring respiratory support, we applied an interpretable random forest classification machine learning pipeline to shotgun metagenomic sequencing data and select clinical covariates. When combined with clinical factors, both species and metabolic pathways abundance-based models were found to be highly predictive of the need for respiratory support (F1-score 0.857 for microbes and 0.821 for functional pathways). To determine biologically meaningful and highly predictive signals in the microbiome, we applied the Stable and Interpretable RUle Set to the output of the models. This analysis revealed that low abundance of two commensal organisms, Prevotella salivae or Veillonella infantium (< 4.2 and 1.7% respectively), and a low abundance of a pathway associated with LPS biosynthesis (< 0.1%) were highly predictive of developing the need for acute respiratory support (82 and 91.4% respectively). These findings suggest that the composition of the oropharyngeal microbiome in COVID-19 patients may play a role in determining who will suffer from severe disease manifestations.
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Affiliation(s)
- Evan S. Bradley
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Evan S. Bradley,
| | - Abigail L. Zeamer
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - Vanni Bucci
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lindsey Cincotta
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Marie-Claire Salive
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Protiva Dutta
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Shafik Mutaawe
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Otuwe Anya
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Christopher Tocci
- Department of Biology and Biotechnology, Worcester Polytechnique Institute, Worcester, MA, United States
| | - Ann Moormann
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Doyle V. Ward
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - Beth A. McCormick
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - John P. Haran
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
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18
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Punches BE, Stolz U, Freiermuth CE, Ancona RM, McLean SA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Kurz MC, Gentile NT, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O’Neil BJ, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Ressler KJ, Koenen KC, Lyons MS. Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study. PLoS One 2022; 17:e0273378. [PMID: 36149896 PMCID: PMC9506640 DOI: 10.1371/journal.pone.0273378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. Methods Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. Results Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). Conclusions ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.
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Affiliation(s)
- Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
- Department of Emergency Medicine College of Medicine, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Uwe Stolz
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Rachel M. Ancona
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, United States of America
| | - Xinming An
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, United States of America
| | - Sarah D. Linnstaedt
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States of America
- The Many Brains Project, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States of America
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Christopher Lewandowski
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States of America
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States of America
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States of America
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States of America
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, United States of America
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Nina T. Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States of America
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, United States of America
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Erica Harris
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, United States of America
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, United States of America
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, United States of America
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, United States of America
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, United States of America
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States of America
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, United States of America
| | - Leon D. Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO, United States of America
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, United States of America
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, MO, United States of America
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States of America
| | - Jordan W. Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, United States of America
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - James M. Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States of America
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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19
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Lebois LAM, Harnett NG, van Rooij SJH, Ely TD, Jovanovic T, Bruce SE, House SL, Ravichandran C, Dumornay NM, Finegold KE, Hill SB, Merker JB, Phillips KA, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Stevens JS, Ressler KJ. Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure. Am J Psychiatry 2022; 179:661-672. [PMID: 35730162 PMCID: PMC9444876 DOI: 10.1176/appi.ajp.21090911] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma. METHODS All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment. RESULTS Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms. CONCLUSIONS The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.
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Affiliation(s)
- Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Caitlin Ravichandran
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Nathalie M Dumornay
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | | | - Sarah B Hill
- Department of Psychology, Northern Illinois University, DeKalb, IL, 60115, USA
| | - Julia B Merker
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Karlye A Phillips
- McLean Hospital, Belmont, MA, 02478, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - John F Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
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20
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Tanriverdi B, Gregory DF, Olino TM, Ely TD, Harnett NG, van Rooij SJH, Lebois LAM, Seligowski AV, Jovanovic T, Ressler KJ, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Domeier RM, Rathlev NK, O'Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, McLean SA, Kessler RC, Koenen KC, Stevens JS, Murty VP. Hippocampal Threat Reactivity Interacts with Physiological Arousal to Predict PTSD Symptoms. J Neurosci 2022; 42:6593-6604. [PMID: 35879096 PMCID: PMC9410748 DOI: 10.1523/jneurosci.0911-21.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
Hippo campal impairments are reliably associated with post-traumatic stress disorder (PTSD); however, little research has characterized how increased threat sensitivity may interact with arousal responses to alter hippocampal reactivity, and further how these interactions relate to the sequelae of trauma-related symptoms. In a sample of individuals recently exposed to trauma (N = 116, 76 female), we found that PTSD symptoms at 2 weeks were associated with decreased hippocampal responses to threat as assessed with fMRI. Further, the relationship between hippocampal threat sensitivity and PTSD symptomology only emerged in individuals who showed transient, high threat-related arousal, as assayed by an independently collected measure of fear potentiated startle. Collectively, our finding suggests that development of PTSD is associated with threat-related decreases in hippocampal function because of increases in fear-potentiated arousal.SIGNIFICANCE STATEMENT Alterations in hippocampal function linked to threat-related arousal are reliably associated with post-traumatic stress disorder (PTSD); however, how these alterations relate to the sequelae of trauma-related symptoms is unknown. Prior models based on nontrauma samples suggest that arousal may impact hippocampal neurophysiology leading to maladaptive behavior. Here we show that decreased hippocampal threat sensitivity interacts with fear-potentiated startle to predict PTSD symptoms. Specifically, individuals with high fear-potentiated startle and low, transient hippocampal threat sensitivity showed the greatest PTSD symptomology. These findings bridge literatures of threat-related arousal and hippocampal function to better understand PTSD risk.
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Affiliation(s)
- Büşra Tanriverdi
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| | - David F Gregory
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Antonia V Seligowski
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan 48202
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and Miriam Hospital, Providence, Rhode Island 02930
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, California 94143
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia 30332
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts 02478
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
- Institute for Technology in Psychiatry/Department of Psychiatry, McLean Hospital, Belmont, Massachusetts 02478
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida 32209
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida 32209
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey 08103
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
- College of Nursing, University of Cincinnati, Cincinnati, Ohio 45221
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama 35294
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, Alabama 35294
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama 35294
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts 02118
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania 19141
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan 48202
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan 48197
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts 01107
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan 48202
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts 02115
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri 63121
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts 02130
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut 06516
- Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut 06510
| | - Jutta Joormann
- Department of Psychology, Yale University, West Haven, Connecticut 06520
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri 63130
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - John F Sheridan
- Department of Biosciences, Ohio State University Wexner Medical Center, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, Ohio 43211
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts 02142
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan 48109
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60208
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Vishnu P Murty
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
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21
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Harnett NG, Finegold KE, Lebois LAM, van Rooij SJH, Ely TD, Murty VP, Jovanovic T, Bruce SE, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Harris E, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Nickerson LD, Ressler KJ, Stevens JS. Structural covariance of the ventral visual stream predicts posttraumatic intrusion and nightmare symptoms: a multivariate data fusion analysis. Transl Psychiatry 2022; 12:321. [PMID: 35941117 PMCID: PMC9360028 DOI: 10.1038/s41398-022-02085-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 01/16/2023] Open
Abstract
Visual components of trauma memories are often vividly re-experienced by survivors with deleterious consequences for normal function. Neuroimaging research on trauma has primarily focused on threat-processing circuitry as core to trauma-related dysfunction. Conversely, limited attention has been given to visual circuitry which may be particularly relevant to posttraumatic stress disorder (PTSD). Prior work suggests that the ventral visual stream is directly related to the cognitive and affective disturbances observed in PTSD and may be predictive of later symptom expression. The present study used multimodal magnetic resonance imaging data (n = 278) collected two weeks after trauma exposure from the AURORA study, a longitudinal, multisite investigation of adverse posttraumatic neuropsychiatric sequelae. Indices of gray and white matter were combined using data fusion to identify a structural covariance network (SCN) of the ventral visual stream 2 weeks after trauma. Participant's loadings on the SCN were positively associated with both intrusion symptoms and intensity of nightmares. Further, SCN loadings moderated connectivity between a previously observed amygdala-hippocampal functional covariance network and the inferior temporal gyrus. Follow-up MRI data at 6 months showed an inverse relationship between SCN loadings and negative alterations in cognition in mood. Further, individuals who showed decreased strength of the SCN between 2 weeks and 6 months had generally higher PTSD symptom severity over time. The present findings highlight a role for structural integrity of the ventral visual stream in the development of PTSD. The ventral visual stream may be particularly important for the consolidation or retrieval of trauma memories and may contribute to efficient reactivation of visual components of the trauma memory, thereby exacerbating PTSD symptoms. Potentially chronic engagement of the network may lead to reduced structural integrity which becomes a risk factor for lasting PTSD symptoms.
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Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | | | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa D Nickerson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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22
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Joormann J, McLean SA, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford G, Linnstaedt SD, Germine LT, Rauch S, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Fermann G, Hudak LA, Mohiuddin K, Murty V, McGrath ME, Haran JP, Pascual J, Seamon M, Peak DA, Pearson C, Domeier RM, Sergot P, Merchant R, Sanchez LD, Rathlev NK, Peacock WF, Bruce SE, Barch D, Pizzagalli DA, Luna B, Harte SE, Hwang I, Lee S, Sampson N, Koenen KC, Ressler K, Kessler RC. Socio-demographic and trauma-related predictors of depression within eight weeks of motor vehicle collision in the AURORA study. Psychol Med 2022; 52:1934-1947. [PMID: 33118917 PMCID: PMC9341273 DOI: 10.1017/s0033291720003773] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. METHODS We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression. RESULTS Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma. CONCLUSIONS These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
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Affiliation(s)
- Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C. Neylan
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA
| | - Gari Clifford
- Department of Biomedical Informatics, Emory University School of Medicine and Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- The Many Brains Project, Acton, MA, USA
| | - Scott Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Gregory Fermann
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University, Grady Memorial Hospital, Atlanta, GA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine/Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Vishnu Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Meghan E. McGrath
- Departmentof Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jose Pascual
- Department of Surgery and Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Pearson
- Wayne State University Department of Emergency Medicine, Ascension St. John Hospital, Detroit, MI, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Roland Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - William F. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Deanna Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Beatriz Luna
- Laboratory of Neurocognitive Development, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kerry Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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23
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Bradley ES, Zeamer AL, Bucci V, Cincotta L, Salive MC, Dutta P, Mutaawe S, Anya O, Tocci C, Moormann A, Ward DV, McCormick BA, Haran JP. Oropharyngeal Microbiome Profiled at Admission is Predictive of the Need for Respiratory Support Among COVID-19 Patients. medRxiv 2022. [PMID: 35262096 PMCID: PMC8902889 DOI: 10.1101/2022.02.28.22271627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The clinical course of infection due to respiratory viruses such as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2), the causative agent of Coronavirus Disease 2019 (COVID-19) is thought to be influenced by the community of organisms that colonizes the upper respiratory tract, the oropharyngeal microbiome. In this study, we examined the oropharyngeal microbiome of suspected COVID-19 patients presenting to the Emergency Department and an inpatient COVID-19 unit with symptoms of acute COVID-19. Of 115 enrolled patients, 74 were confirmed COVID-19+ and 50 had symptom duration of 14 days or less; 38 acute COVID-19+ patients (76%) went on to require respiratory support. Although no microbiome features were found to be significantly different between COVID-19+ and COVID-19-patients, when we conducted random forest classification modeling (RFC) to predict the need of respiratory support for the COVID-19+ patients our analysis identified a subset of organisms and metabolic pathways whose relative abundance, when combined with clinical factors (such as age and Body Mass Index), was highly predictive of the need for respiratory support (F1 score 0.857). Microbiome Multivariable Association with Linear Models (MaAsLin2) analysis was then applied to the features identified as predicative of the need for respiratory support by the RFC. This analysis revealed reduced abundance of Prevotella salivae and metabolic pathways associated with lipopolysaccharide and mycolic acid biosynthesis to be the strongest predictors of patients requiring respiratory support. These findings suggest that composition of the oropharyngeal microbiome in COVID-19 may play a role in determining who will suffer from severe disease manifestations. Importance The microbial community that colonizes the upper airway, the oropharyngeal microbiome, has the potential to affect how patients respond to respiratory viruses such as SARS-CoV2, the causative agent of COVID-19. In this study, we investigated the oropharyngeal microbiome of COVID-19 patients using high throughput DNA sequencing performed on oral swabs. We combined patient characteristics available at intake such as medical comorbidities and age, with measured abundance of bacterial species and metabolic pathways and then trained a machine learning model to determine what features are predicative of patients needing respiratory support in the form of supplemental oxygen or mechanical ventilation. We found that decreased abundance of some bacterial species and increased abundance of pathways associated bacterial products biosynthesis was highly predictive of needing respiratory support. This suggests that the oropharyngeal microbiome affects disease course in COVID-19 and could be targeted for diagnostic purposes to determine who may need oxygen, or therapeutic purposes such as probiotics to prevent severe COVID-19 disease manifestations.
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24
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Haran JP, Ward DV, Bhattarai SK, Loew E, Dutta P, Higgins A, McCormick BA, Bucci V. The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome. Gut Microbes 2022; 13:1-15. [PMID: 33764826 PMCID: PMC8007149 DOI: 10.1080/19490976.2021.1897209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization.We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history.We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22-0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence.C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH.
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Affiliation(s)
- John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA,Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA,CONTACT John P. Haran Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA01655
| | - Doyle V. Ward
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Shakti K. Bhattarai
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ethan Loew
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amanda Higgins
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Beth A. McCormick
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vanni Bucci
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
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25
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Joormann J, Ziobrowski HN, King A, Gildea SM, Lee S, Sampson NA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Koenen KC, McLean SA, Kessler RC. Prior histories of posttraumatic stress disorder and major depression and their onset and course in the three months after a motor vehicle collision in the AURORA study. Depress Anxiety 2022; 39:56-70. [PMID: 34783142 PMCID: PMC8732322 DOI: 10.1002/da.23223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/17/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A better understanding of the extent to which prior occurrences of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) predict psychopathological reactions to subsequent traumas might be useful in targeting posttraumatic preventive interventions. METHODS Data come from 1306 patients presenting to 29 U.S. emergency departments (EDs) after a motor vehicle collision (MVC) in the advancing understanding of recovery after trauma study. Patients completed self-reports in the ED and 2-weeks, 8-weeks, and 3-months post-MVC. Associations of pre-MVC probable PTSD and probable MDE histories with subsequent 3-months post-MVC probable PTSD and probable MDE were examined along with mediation through intervening peritraumatic, 2-, and 8-week disorders. RESULTS 27.6% of patients had 3-month post-MVC probable PTSD and/or MDE. Pre-MVC lifetime histories of these disorders were not only significant (relative risk = 2.6-7.4) but were dominant (63.1% population attributable risk proportion [PARP]) predictors of this 3-month outcome, with 46.6% prevalence of the outcome among patients with pre-MVC disorder histories versus 9.9% among those without such histories. The associations of pre-MVC lifetime disorders with the 3-month outcome were mediated largely by 2- and 8-week probable PTSD and MDE (PARP decreasing to 22.8% with controls for these intervening disorders). Decomposition showed that pre-MVC lifetime histories predicted both onset and persistence of these intervening disorders as well as the higher conditional prevalence of the 3-month outcome in the presence of these intervening disorders. CONCLUSIONS Assessments of pre-MVC PTSD and MDE histories and follow-ups at 2 and 8 weeks could help target early interventions for psychopathological reactions to MVCs.
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Affiliation(s)
- Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew King
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, 02930, USA
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Providence, RI, 02930, USA
- Rhode Island Hospital, Providence, RI, 02930, USA
- The Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C. Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T. Germine
- Department of Biomedical Engineering, Emory University, Atlanta, GA, 30332, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Kenneth A. Bollen
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L. Pascual
- Department of Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St. Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, 2006, Australia
- Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
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Pilishvili T, Gierke R, Fleming-Dutra KE, Farrar JL, Mohr NM, Talan DA, Krishnadasan A, Harland KK, Smithline HA, Hou PC, Lee LC, Lim SC, Moran GJ, Krebs E, Steele MT, Beiser DG, Faine B, Haran JP, Nandi U, Schrading WA, Chinnock B, Henning DJ, Lovecchio F, Lee J, Barter D, Brackney M, Fridkin SK, Marceaux-Galli K, Lim S, Phipps EC, Dumyati G, Pierce R, Markus TM, Anderson DJ, Debes AK, Lin MY, Mayer J, Kwon JH, Safdar N, Fischer M, Singleton R, Chea N, Magill SS, Verani JR, Schrag SJ. Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel. N Engl J Med 2021; 385:e90. [PMID: 34551224 PMCID: PMC8482809 DOI: 10.1056/nejmoa2106599] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The prioritization of U.S. health care personnel for early receipt of messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), allowed for the evaluation of the effectiveness of these new vaccines in a real-world setting. METHODS We conducted a test-negative case-control study involving health care personnel across 25 U.S. states. Cases were defined on the basis of a positive polymerase-chain-reaction (PCR) or antigen-based test for SARS-CoV-2 and at least one Covid-19-like symptom. Controls were defined on the basis of a negative PCR test for SARS-CoV-2, regardless of symptoms, and were matched to cases according to the week of the test date and site. Using conditional logistic regression with adjustment for age, race and ethnic group, underlying conditions, and exposures to persons with Covid-19, we estimated vaccine effectiveness for partial vaccination (assessed 14 days after receipt of the first dose through 6 days after receipt of the second dose) and complete vaccination (assessed ≥7 days after receipt of the second dose). RESULTS The study included 1482 case participants and 3449 control participants. Vaccine effectiveness for partial vaccination was 77.6% (95% confidence interval [CI], 70.9 to 82.7) with the BNT162b2 vaccine (Pfizer-BioNTech) and 88.9% (95% CI, 78.7 to 94.2) with the mRNA-1273 vaccine (Moderna); for complete vaccination, vaccine effectiveness was 88.8% (95% CI, 84.6 to 91.8) and 96.3% (95% CI, 91.3 to 98.4), respectively. Vaccine effectiveness was similar in subgroups defined according to age (<50 years or ≥50 years), race and ethnic group, presence of underlying conditions, and level of patient contact. Estimates of vaccine effectiveness were lower during weeks 9 through 14 than during weeks 3 through 8 after receipt of the second dose, but confidence intervals overlapped widely. CONCLUSIONS The BNT162b2 and mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Tamara Pilishvili
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Ryan Gierke
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Katherine E Fleming-Dutra
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Jennifer L Farrar
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Nicholas M Mohr
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - David A Talan
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Anusha Krishnadasan
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Karisa K Harland
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Howard A Smithline
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Peter C Hou
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Lilly C Lee
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Stephen C Lim
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Gregory J Moran
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Elizabeth Krebs
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Mark T Steele
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - David G Beiser
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Brett Faine
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - John P Haran
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Utsav Nandi
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Walter A Schrading
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Brian Chinnock
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Daniel J Henning
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Frank Lovecchio
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Jane Lee
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Devra Barter
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Monica Brackney
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Scott K Fridkin
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Kaytlynn Marceaux-Galli
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Sarah Lim
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Erin C Phipps
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Ghinwa Dumyati
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Rebecca Pierce
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Tiffanie M Markus
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Deverick J Anderson
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Amanda K Debes
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Michael Y Lin
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Jeanmarie Mayer
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Jennie H Kwon
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Nasia Safdar
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Marc Fischer
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Rosalyn Singleton
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Nora Chea
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Shelley S Magill
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Jennifer R Verani
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
| | - Stephanie J Schrag
- From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.)
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Bradley ES, Schell B, Ward DV, Bucci V, Zeamer A, Haran JP. The Urinary Microbiome of Older Adults Residing in a Nursing Home Varies with Duration of Residence and Shows Increases in Potential Pathogens. J Gerontol A Biol Sci Med Sci 2021; 77:1313-1320. [PMID: 34791238 DOI: 10.1093/gerona/glab345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
The community of bacteria that colonize the urinary tract, the urinary microbiome, is hypothesized to influence a wide variety of urinary tract conditions. Older adults that reside in nursing homes are frequently diagnosed and treated for urinary tract conditions such as urinary tract infection (UTI). We investigated the urinary microbiome of older adults residing in a nursing home to determine if there are features of the urinary microbiome that are associated specific conditions and exposure in this population. We were also interested in the stability of urinary microbiome over time and in similarities between the urinary and gastrointestinal microbiome. Urine samples were prospectively collected over a period of 10 months from a cohort of 26 older adults (age > 65 years) residing in single nursing home located in Central Massachusetts. Serial samples were obtained from 6 individuals over 10 months and 5 participants were concurrently enrolled in a study of the gastrointestinal microbiome. Information collected on participants included demographics, medical history, duration of residence in the nursing home, frailty, dementia symptoms, urinary symptoms, antibiotic treatment, urinary catherization, and hospitalizations over a 10-month period. Clean catch mid-stream urine samples were collected and stored at -80C. DNA was extracted and 16S rRNA gene sequencing performed. The length of stay in the nursing facility and the Clinical Frailty Scale correlated with significant changes in microbiome composition. An increase in the relative abundance of a putative urinary pathogen, Aerococcus urinae, was the largest factor influencing change that occurred over duration of residence.
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Affiliation(s)
- Evan S Bradley
- Department of Emergency Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, MA.,Program in Microbiome Dynamics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA
| | - Brent Schell
- Department of Emergency Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, MA
| | - Doyle V Ward
- Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester MA.,Program in Microbiome Dynamics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA
| | - Vanni Bucci
- Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester MA.,Program in Microbiome Dynamics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA
| | - Abigail Zeamer
- Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester MA
| | - John P Haran
- Department of Emergency Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, MA.,Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester MA.,Program in Microbiome Dynamics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA
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Ziobrowski HN, Kennedy CJ, Ustun B, House SL, Beaudoin FL, An X, Zeng D, Bollen KA, Petukhova M, Sampson NA, Puac-Polanco V, Lee S, Koenen KC, Ressler KJ, McLean SA, Kessler RC, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Lyons MS, Murty VP, McGrath ME, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Jambaulikar G, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, van Rooij SJH. Development and Validation of a Model to Predict Posttraumatic Stress Disorder and Major Depression After a Motor Vehicle Collision. JAMA Psychiatry 2021; 78:1228-1237. [PMID: 34468741 PMCID: PMC8411364 DOI: 10.1001/jamapsychiatry.2021.2427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE A substantial proportion of the 40 million people in the US who present to emergency departments (EDs) each year after traumatic events develop posttraumatic stress disorder (PTSD) or major depressive episode (MDE). Accurately identifying patients at high risk in the ED would facilitate the targeting of preventive interventions. OBJECTIVES To develop and validate a prediction tool based on ED reports after a motor vehicle collision to predict PTSD or MDE 3 months later. DESIGN, SETTING, AND PARTICIPANTS The Advancing Understanding of Recovery After Trauma (AURORA) study is a longitudinal study that examined adverse posttraumatic neuropsychiatric sequalae among patients who presented to 28 US urban EDs in the immediate aftermath of a traumatic experience. Enrollment began on September 25, 2017. The 1003 patients considered in this diagnostic/prognostic report completed 3-month assessments by January 31, 2020. Each patient received a baseline ED assessment along with follow-up self-report surveys 2 weeks, 8 weeks, and 3 months later. An ensemble machine learning method was used to predict 3-month PTSD or MDE from baseline information. Data analysis was performed from November 1, 2020, to May 31, 2021. MAIN OUTCOMES AND MEASURES The PTSD Checklist for DSM-5 was used to assess PTSD and the Patient Reported Outcomes Measurement Information System Depression Short-Form 8b to assess MDE. RESULTS A total of 1003 patients (median [interquartile range] age, 34.5 [24-43] years; 715 [weighted 67.9%] female; 100 [weighted 10.7%] Hispanic, 537 [weighted 52.7%] non-Hispanic Black, 324 [weighted 32.2%] non-Hispanic White, and 42 [weighted 4.4%] of non-Hispanic other race or ethnicity were included in this study. A total of 274 patients (weighted 26.6%) met criteria for 3-month PTSD or MDE. An ensemble machine learning model restricted to 30 predictors estimated in a training sample (patients from the Northeast or Midwest) had good prediction accuracy (mean [SE] area under the curve [AUC], 0.815 [0.031]) and calibration (mean [SE] integrated calibration index, 0.040 [0.002]; mean [SE] expected calibration error, 0.039 [0.002]) in an independent test sample (patients from the South). Patients in the top 30% of predicted risk accounted for 65% of all 3-month PTSD or MDE, with a mean (SE) positive predictive value of 58.2% (6.4%) among these patients at high risk. The model had good consistency across regions of the country in terms of both AUC (mean [SE], 0.789 [0.025] using the Northeast as the test sample and 0.809 [0.023] using the Midwest as the test sample) and calibration (mean [SE] integrated calibration index, 0.048 [0.003] using the Northeast as the test sample and 0.024 [0.001] using the Midwest as the test sample; mean [SE] expected calibration error, 0.034 [0.003] using the Northeast as the test sample and 0.025 [0.001] using the Midwest as the test sample). The most important predictors in terms of Shapley Additive Explanations values were symptoms of anxiety sensitivity and depressive disposition, psychological distress in the 30 days before motor vehicle collision, and peritraumatic psychosomatic symptoms. CONCLUSIONS AND RELEVANCE The results of this study suggest that a short set of questions feasible to administer in an ED can predict 3-month PTSD or MDE with good AUC, calibration, and geographic consistency. Patients at high risk can be identified in the ED for targeting if cost-effective preventive interventions are developed.
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Affiliation(s)
| | - Chris J. Kennedy
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Berk Ustun
- Halıcıoğlu Data Science Institute, University of California, San Diego
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill,Department of Emergency Medicine, University of North Carolina at Chapel Hill
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California, San Francisco
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,The Many Brains Project, Belmont, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,College of Nursing, University of Cincinnati, Cincinnati, Ohio.,Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mark J Seamon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania.,Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | | | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan
| | - Paulina Sergot
- McGovern Medical School, University of Texas Health Science Center, Houston
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St Louis
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven.,Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut
| | - Jutta Joormann
- Department of Psychology, Yale University, West Haven, Connecticut
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St Louis, Missouri
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts.,Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - John F Sheridan
- Department of Biosciences and Neuroscience, Wexner Medical Center, The Ohio State University, Columbus.,Institute for Behavioral Medicine Research, Wexner Medical Center, The Ohio State University, Columbus
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.,Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia.,Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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Seligowski AV, Steuber ER, Hinrichs R, Reda MH, Wiltshire CN, Wanna CP, Winters SJ, Phillips KA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Guffanti G, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Murty VP, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Luna B, Harte SE, Elliott JM, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Jovanovic T. A prospective examination of sex differences in posttraumatic autonomic functioning. Neurobiol Stress 2021; 15:100384. [PMID: 34485632 PMCID: PMC8397921 DOI: 10.1016/j.ynstr.2021.100384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning. METHODS 192 participants were recruited from emergency departments following trauma exposure (Mean age = 35.88, 68.2% female). Skin conductance was measured in the emergency department; fear conditioning was completed two weeks later and included measures of blood pressure (BP), heart rate (HR), and high frequency heart rate variability (HF-HRV). PTSD symptoms were assessed 8 weeks after trauma. RESULTS 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR levels. Two-week HF-HRV was significantly lower in women, and a sex by PTSD interaction suggested that women with PTSD demonstrated the lowest HF-HRV levels. Skin conductance response in the emergency department was associated with 2-week HR and HF-HRV only among women who developed PTSD. CONCLUSIONS Our results indicate that there are notable sex differences in autonomic functioning among trauma-exposed individuals. Differences in sympathetic biomarkers (BP and HR) may have implications for cardiovascular disease risk given that sympathetic arousal is a mechanism implicated in this risk among PTSD populations. Future research examining differential pathways between PTSD and cardiovascular risk among men versus women is warranted.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | | | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Mariam H. Reda
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | | | - Cassandra P. Wanna
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Sterling J. Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Karlye A. Phillips
- McLean Hospital, Belmont, MA, 02478, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and the Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T. Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Scott L. Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Vishnu P. Murty
- Department of Psychology, Temple University, Philadelphia, PA, 19121, USA
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Elizabeth M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J. O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - John F. Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
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Stevens JS, Harnett NG, Lebois LAM, van Rooij SJH, Ely TD, Roeckner A, Vincent N, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Lewandowski C, Storrow AB, Hendry PL, Sheikh S, Musey PI, Haran JP, Jones CW, Punches BE, Lyons MS, Kurz MC, McGrath ME, Pascual JL, Datner EM, Chang AM, Pearson C, Peak DA, Domeier RM, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Luna B, Harte SE, Elliott JM, Murty VP, Jovanovic T, Bruce SE, House SL, Kessler RC, Koenen KC, McLean SA, Ressler KJ. Brain-Based Biotypes of Psychiatric Vulnerability in the Acute Aftermath of Trauma. Am J Psychiatry 2021; 178:1037-1049. [PMID: 34645277 PMCID: PMC9069566 DOI: 10.1176/appi.ajp.2021.20101526] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Major negative life events, such as trauma exposure, can play a key role in igniting or exacerbating psychopathology. However, few disorders are diagnosed with respect to precipitating events, and the role of these events in the unfolding of new psychopathology is not well understood. The authors conducted a multisite transdiagnostic longitudinal study of trauma exposure and related mental health outcomes to identify neurobiological predictors of risk, resilience, and different symptom presentations. METHODS A total of 146 participants (discovery cohort: N=69; internal replication cohort: N=77) were recruited from emergency departments within 72 hours of a trauma and followed for the next 6 months with a survey, MRI, and physiological assessments. RESULTS Task-based functional MRI 2 weeks after a motor vehicle collision identified four clusters of individuals based on profiles of neural activity reflecting threat reactivity, reward reactivity, and inhibitory engagement. Three clusters were replicated in an independent sample with a variety of trauma types. The clusters showed different longitudinal patterns of posttrauma symptoms. CONCLUSIONS These findings provide a novel characterization of heterogeneous stress responses shortly after trauma exposure, identifying potential neuroimaging-based biotypes of trauma resilience and psychopathology.
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Affiliation(s)
- Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Nathaniel G Harnett
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Lauren A M Lebois
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Alyssa Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Nico Vincent
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Francesca L Beaudoin
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Xinming An
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Donglin Zeng
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Thomas C Neylan
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Gari D Clifford
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Sarah D Linnstaedt
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Laura T Germine
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Scott L Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Christopher Lewandowski
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Alan B Storrow
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Phyllis L Hendry
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Sophia Sheikh
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Paul I Musey
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - John P Haran
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Christopher W Jones
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Brittany E Punches
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Michael S Lyons
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Michael C Kurz
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Meghan E McGrath
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Jose L Pascual
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Elizabeth M Datner
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Anna M Chang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Claire Pearson
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - David A Peak
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Robert M Domeier
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Brian J O'Neil
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Niels K Rathlev
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Leon D Sanchez
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Robert H Pietrzak
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Jutta Joormann
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Deanna M Barch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Diego A Pizzagalli
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - John F Sheridan
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Beatriz Luna
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Steven E Harte
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - James M Elliott
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Vishnu P Murty
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Steven E Bruce
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Stacey L House
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Ronald C Kessler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Karestan C Koenen
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Samuel A McLean
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
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Haran JP, Bradley E, Zeamer AL, Cincotta L, Salive MC, Dutta P, Mutaawe S, Anya O, Meza-Segura M, Moormann AM, Ward DV, McCormick BA, Bucci V. Inflammation-type dysbiosis of the oral microbiome associates with the duration of COVID-19 symptoms and long COVID. JCI Insight 2021; 6:e152346. [PMID: 34403368 PMCID: PMC8564890 DOI: 10.1172/jci.insight.152346] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
In the COVID-19 pandemic, caused by SARS-CoV-2, many individuals experience prolonged symptoms, termed long-lasting COVID-19 symptoms (long COVID). Long COVID is thought to be linked to immune dysregulation due to harmful inflammation, with the exact causes being unknown. Given the role of the microbiome in mediating inflammation, we aimed to examine the relationship between the oral microbiome and the duration of long COVID symptoms. Tongue swabs were collected from patients presenting with COVID-19 symptoms. Confirmed infections were followed until resolution of all symptoms. Bacterial composition was determined by metagenomic sequencing. We used random forest modeling to identify microbiota and clinical covariates that are associated with long COVID symptoms. Of the patients followed, 63% developed ongoing symptomatic COVID-19 and 37% went on to long COVID. Patients with prolonged symptoms had significantly higher abundances of microbiota that induced inflammation, such as members of the genera Prevotella and Veillonella, which, of note, are species that produce LPS. The oral microbiome of patients with long COVID was similar to that of patients with chronic fatigue syndrome. Altogether, our findings suggest an association with the oral microbiome and long COVID, revealing the possibility that dysfunction of the oral microbiome may have contributed to this draining disease.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine.,Department of Microbiology and Physiological Systems.,Program in Microbiome Dynamics, and
| | - Evan Bradley
- Department of Emergency Medicine.,Program in Microbiome Dynamics, and
| | - Abigail L Zeamer
- Department of Microbiology and Physiological Systems.,Program in Microbiome Dynamics, and
| | | | | | | | | | | | | | - Ann M Moormann
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Doyle V Ward
- Department of Microbiology and Physiological Systems.,Program in Microbiome Dynamics, and
| | - Beth A McCormick
- Department of Microbiology and Physiological Systems.,Program in Microbiome Dynamics, and
| | - Vanni Bucci
- Department of Microbiology and Physiological Systems.,Program in Microbiome Dynamics, and
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32
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Haran JP, Zeamer A, Ward DV, Dutta P, Bucci V, McCormick BA. The Nursing Home Older Adult Gut Microbiome Composition Shows Time-dependent Dysbiosis and Is Influenced by Medication Exposures, Age, Environment, and Frailty. J Gerontol A Biol Sci Med Sci 2021; 76:1930-1938. [PMID: 34125200 PMCID: PMC8514073 DOI: 10.1093/gerona/glab167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 12/30/2022] Open
Abstract
Older adults in nursing homes (NHs) have increased frailty, medication, and antimicrobial exposures, all factors that are known to affect the composition of gut microbiota. Our objective was to define which factors have the greatest association with the NH resident gut microbiota, explore patterns of dysbiosis and compositional changes in gut microbiota over time in this environment. We collected serial stool samples from NH residents. Residents were assessed using the Mini Nutritional Assessment tool and Clinical Frailty Scale. Bacterial composition of resident stool samples was determined by metagenomic sequencing. We used mixed-effect random forest modeling to identify clinical covariates that associate with microbiota. We enrolled and followed 166 residents from 5 NHs collecting 512 stool samples and following 15 residents for > 1 year. Medications, particularly psychoactive and antihypertensive medications, had the greatest effect on the microbiota. Age and frailty also contributed, and were associated with increased and decreased diversity, respectively. The microbiota of residents who had lived in the NH for > 1 year were enriched in inflammatory and pathogenic species and reduced in anti-inflammatory and symbiotic species. We observed intraindividual stability of the microbiome among older adults who had lived in the NH already for >1 year followed with sample collections 1 year apart. Older adult NH gut microbiome is heavily influenced by medications, age, and frailty. This microbiome is influenced by the length of NH residency with dysbiosis becoming evident at 12 months, however, after this point there is demonstrated relative stability over time.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, USA
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, USA
| | - Abigail Zeamer
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, USA
| | - Doyle V Ward
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Vanni Bucci
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, USA
| | - Beth A McCormick
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, USA
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33
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Cakmak AS, Alday EAP, Da Poian G, Rad AB, Metzler TJ, Neylan TC, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Lewandowski CA, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, Gentile NT, McGrath ME, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Domeier RM, Bruce SE, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, Ressler KJ, Mclean SA, Li Q, Clifford GD. Classification and Prediction of Post-Trauma Outcomes Related to PTSD Using Circadian Rhythm Changes Measured via Wrist-Worn Research Watch in a Large Longitudinal Cohort. IEEE J Biomed Health Inform 2021; 25:2866-2876. [PMID: 33481725 PMCID: PMC8395207 DOI: 10.1109/jbhi.2021.3053909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition resulting from threatening or horrifying events. We hypothesized that circadian rhythm changes, measured by a wrist-worn research watch are predictive of post-trauma outcomes. APPROACH 1618 post-trauma patients were enrolled after admission to emergency departments (ED). Three standardized questionnaires were administered at week eight to measure post-trauma outcomes related to PTSD, sleep disturbance, and pain interference with daily life. Pulse activity and movement data were captured from a research watch for eight weeks. Standard and novel movement and cardiovascular metrics that reflect circadian rhythms were derived using this data. These features were used to train different classifiers to predict the three outcomes derived from week-eight surveys. Clinical surveys administered at ED were also used as features in the baseline models. RESULTS The highest cross-validated performance of research watch-based features was achieved for classifying participants with pain interference by a logistic regression model, with an area under the receiver operating characteristic curve (AUC) of 0.70. The ED survey-based model achieved an AUC of 0.77, and the fusion of research watch and ED survey metrics improved the AUC to 0.79. SIGNIFICANCE This work represents the first attempt to predict and classify post-trauma symptoms from passive wearable data using machine learning approaches that leverage the circadian desynchrony in a potential PTSD population.
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Kessler RC, Ressler KJ, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Linnstaedt SD, Germine LT, Musey PI, Hendry PL, Sheikh S, Storrow AB, Jones CW, Punches BE, Datner EM, Mohiuddin K, Gentile NT, McGrath ME, van Rooij SJ, Hudak LA, Haran JP, Peak DA, Domeier RM, Pearson C, Sanchez LD, Rathlev NK, Peacock WF, Bruce SE, Miller MW, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Pace TWW, Harte SE, Elliott JM, Harnett NG, Lebois LAM, Hwang I, Sampson NA, Koenen KC, McLean SA. Socio-demographic and trauma-related predictors of PTSD within 8 weeks of a motor vehicle collision in the AURORA study. Mol Psychiatry 2021; 26:3108-3121. [PMID: 33077855 PMCID: PMC8053721 DOI: 10.1038/s41380-020-00911-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 09/18/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023]
Abstract
This is the initial report of results from the AURORA multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. We focus on n = 666 participants presenting to EDs following a motor vehicle collision (MVC) and examine associations of participant socio-demographic and participant-reported MVC characteristics with 8-week posttraumatic stress disorder (PTSD) adjusting for pre-MVC PTSD and mediated by peritraumatic symptoms and 2-week acute stress disorder (ASD). Peritraumatic Symptoms, ASD, and PTSD were assessed with self-report scales. Eight-week PTSD prevalence was relatively high (42.0%) and positively associated with participant sex (female), low socioeconomic status (education and income), and several self-report indicators of MVC severity. Most of these associations were entirely mediated by peritraumatic symptoms and, to a lesser degree, ASD, suggesting that the first 2 weeks after trauma may be a uniquely important time period for intervening to prevent and reduce risk of PTSD. This observation, coupled with substantial variation in the relative strength of mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated with more in-depth analyses of the rich and evolving AURORA data.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Acton, MA, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Sanne J van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emergency Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Claire Pearson
- Wayne State University Department of Emergency Medicine, Ascension St. John Hospital, Detroit, MI, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - William F Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | | | - John F Sheridan
- Department of Neuroscience, Ohio State University Wexner Medical Center, Columbus, OH, USA
- College of Dentistry Division of Bioscience, Ohio State University, Columbus, OH, USA
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Thaddeus W W Pace
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
- Faculty of Health Sciences, University of Sydney, St Leonards, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nathaniel G Harnett
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Lauren A M Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Harnett NG, van Rooij SJH, Ely TD, Lebois LAM, Murty VP, Jovanovic T, Hill SB, Dumornay NM, Merker JB, Bruce SE, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Lewandowski C, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, McGrath ME, Pascual JL, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, Mclean S, Ressler KJ, Stevens JS. Prognostic neuroimaging biomarkers of trauma-related psychopathology: resting-state fMRI shortly after trauma predicts future PTSD and depression symptoms in the AURORA study. Neuropsychopharmacology 2021; 46:1263-1271. [PMID: 33479509 PMCID: PMC8134491 DOI: 10.1038/s41386-020-00946-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
Neurobiological markers of future susceptibility to posttraumatic stress disorder (PTSD) may facilitate identification of vulnerable individuals in the early aftermath of trauma. Variability in resting-state networks (RSNs), patterns of intrinsic functional connectivity across the brain, has previously been linked to PTSD, and may thus be informative of PTSD susceptibility. The present data are part of an initial analysis from the AURORA study, a longitudinal, multisite study of adverse neuropsychiatric sequalae. Magnetic resonance imaging (MRI) data from 109 recently (i.e., ~2 weeks) traumatized individuals were collected and PTSD and depression symptoms were assessed at 3 months post trauma. We assessed commonly reported RSNs including the default mode network (DMN), central executive network (CEN), and salience network (SN). We also identified a proposed arousal network (AN) composed of a priori brain regions important for PTSD: the amygdala, hippocampus, mamillary bodies, midbrain, and pons. Primary analyses assessed whether variability in functional connectivity at the 2-week imaging timepoint predicted 3-month PTSD symptom severity. Left dorsolateral prefrontal cortex (DLPFC) to AN connectivity at 2 weeks post trauma was negatively related to 3-month PTSD symptoms. Further, right inferior temporal gyrus (ITG) to DMN connectivity was positively related to 3-month PTSD symptoms. Both DLPFC-AN and ITG-DMN connectivity also predicted depression symptoms at 3 months. Our results suggest that, following trauma exposure, acutely assessed variability in RSN connectivity was associated with PTSD symptom severity approximately two and a half months later. However, these patterns may reflect general susceptibility to posttraumatic dysfunction as the imaging patterns were not linked to specific disorder symptoms, at least in the subacute/early chronic phase. The present data suggest that assessment of RSNs in the early aftermath of trauma may be informative of susceptibility to posttraumatic dysfunction, with future work needed to understand neural markers of long-term (e.g., 12 months post trauma) dysfunction. Furthermore, these findings are consistent with neural models suggesting that decreased top-down cortico-limbic regulation and increased network-mediated fear generalization may contribute to ongoing dysfunction in the aftermath of trauma.
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Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sarah B Hill
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | | | - Julia B Merker
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Steve E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, Springfield, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, Rhode Island Hospital and The Miriam Hospital, The Alpert Medical School of Brown University, Providence, RI, USA
| | - Xinming An
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience, Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, College of Medicine & College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MO, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John F Sheridan
- Department of Biosciences and Neuroscience, OSU Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel Mclean
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
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Pilishvili T, Fleming-Dutra KE, Farrar JL, Gierke R, Mohr NM, Talan DA, Krishnadasan A, Harland KK, Smithline HA, Hou PC, Lee LC, Lim SC, Moran GJ, Krebs E, Steele M, Beiser DG, Faine B, Haran JP, Nandi U, Schrading WA, Chinnock B, Henning DJ, LoVecchio F, Nadle J, Barter D, Brackney M, Britton A, Marceaux-Galli K, Lim S, Phipps EC, Dumyati G, Pierce R, Markus TM, Anderson DJ, Debes AK, Lin M, Mayer J, Babcock HM, Safdar N, Fischer M, Singleton R, Chea N, Magill SS, Verani J, Schrag S. Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel - 33 U.S. Sites, January-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:753-758. [PMID: 34014909 PMCID: PMC8136422 DOI: 10.15585/mmwr.mm7020e2] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Haran JP, Zheng Y, Alonzo-Palma N, Wingertzahn M. Patient-reported comorbidity affects symptom duration in non-hospitalized patients with mild to moderate COVID-19 in a clinical study. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.62.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Background:
Most COVID-19 cases in the US are managed via outpatient care, yet the outpatient natural history of COVID-19 is not well understood. We assessed outpatient natural history of COVID-19 as part of a clinical food study evaluating KB109 safety and its effects on select health measures when combined with supportive self-care (SSC) vs SSC alone. KB109 is a novel synthetic glycan developed to support immune system homeostasis through gut microbiome modulation. The SSC-alone arm permitted COVID-19 natural history exploration, the focus of this abstract.
Methods:
Adult patients were randomized 1:1 to SSC alone or SSC+KB109. Randomization was stratified by site, age subgroup, and comorbidity status. Signs/symptoms of COVID-19 and other end points were evaluated over a 35-d study period. Patients self-assessed 8 COVID-19–related cardinal symptoms; 5 additional symptoms were collected (13 overall symptoms).
Results:
Overall, 350 patients were randomized (SSC alone, n=176). Interim results are presented; full analysis expected in March 2021. In the SSC-alone interim results (n=89), 36.0% of patients self-reported ≥1 comorbidity. Median time to resolution of the 8 cardinal symptoms was 12d in patients with no comorbidities vs 27d in patients with ≥1 comorbidity (HR=1.708 [0.875, 3.332]). Median time to resolution of the 13 overall symptoms was 14d in patients with no comorbidities vs 27d in patients reporting ≥1 comorbidity (HR=1.800 [0.953, 3.400]). The most common comorbidities were hypertension (19.1%) and chronic lung disease (9.0%).
Conclusions:
This is the first clinical study to show ≥1 comorbidity is associated with a protracted time to resolution of symptoms in non-hospitalized patients with mild to moderate COVID-19.
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Haran JP, Pinero JC, Zheng Y, Palma NA, Wingertzahn M. Virtualized clinical studies to assess the natural history and impact of gut microbiome modulation in non-hospitalized patients with mild to moderate COVID-19 a randomized, open-label, prospective study with a parallel group study evaluating the physiologic effects of KB109 on gut microbiota structure and function: a structured summary of a study protocol for a randomized controlled study. Trials 2021; 22:245. [PMID: 33810796 PMCID: PMC8017509 DOI: 10.1186/s13063-021-05157-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES These 2 parallel studies (K031 and K032) aim to evaluate the safety of KB109 in addition to supportive self-care (SSC) compared with SSC alone in outpatients with mild to moderate coronavirus disease 2019 (COVID-19). KB109 is a novel synthetic glycan that was formulated to modulate the gut microbiome composition and metabolic output in order to increase beneficial short-chain fatty acid (SCFA) production in the gut. The K031 study is designed to evaluate the safety of KB109 and characterize its impact on the natural progression of COVID-19 in patients with mild to moderate disease. The K032 study is evaluating the effect of KB109 on the gut microbiota structure and function in this same patient population. Additionally, both studies are evaluating measures of health care utilization, quality of life (QOL), laboratory indices, biomarkers of inflammation, and serological measures of immunity in patients who received SSC alone or with KB109. Noteworthy aspects of these outpatient studies include study design measures aimed at limiting in-person interactions to minimize the risk of infection spread, such as use of online diaries, telemedicine, and at-home sample collection. STUDY DESIGN K031 and K032 are randomized, controlled, open-label, clinical food studies. PARTICIPANTS Inclusion Criteria: • Adults ≥18 years of age • Patients willing and able to give informed consent • Screening/randomization telemedicine visit within 2 days of testing positive test for COVID-19 ○ In K031 study, symptomatic patients at COVID-19 testing must report new or worsening symptoms at baseline that have not been present for more than 5 days ▪ Cardinal COVID-19 symptoms include fever, chills/repeated shaking with chills, cough, shortness of breath, headache, muscle pain, anosmia/ageusia, and sore throat. The 5 additional symptoms include gastrointestinal (GI) disturbance/symptoms (other than diarrhea), diarrhea, fatigue, nasal congestion, and chest tightness ○ In K031, at COVID-19 testing, pre-symptomatic patients must report new cardinal COVID-19 symptoms within 7 days of a positive test and they must be screened and randomized within 5 days of developing symptoms • Mild to moderate COVID-19 and self-reported outpatient management ○ In K032, mild to moderate COVID-19 was defined as having the following symptoms for no more than 72 hours before COVID-19 testing: a self- reported fever or cough (new or exacerbated) or presence of at least 2 of the following: anosmia, sore throat, or nasal congestion • Ability to adhere to the study visit schedule and other protocol requirements • Consistent internet or cell phone access with a data plan and access to a smartphone, tablet, or computer • The K031 and K032 studies are currently being conducted at 17 clinical institutions throughout the United States. EXCLUSION CRITERIA • In the primary investigator's (PI) judgement, patients likely to require hospitalization for COVID-19 • Patients who are hospitalized for in-patient treatment or currently being evaluated for potential hospitalization at the time of informed consent for conditions other than COVID-19 • History of chronic lung disease with chronic hypoxia • History of documented cirrhosis or end-stage liver disease • Ongoing requirement for oxygen therapy • Shortness of breath in resting position • Diagnosis of sleep apnea requiring bilevel positive airway pressure (BIPAP)/continuous positive airway pressure (CPAP) • Female patients who are pregnant, trying to become pregnant, or lactating • Concurrent use of immunomodulatory agent within 12 months; systemic antibiotics, antifungals, or antivirals for treatment of active infection within 28 days; systemic immunosuppressive therapy within 3 months; or drugs or other compounds that modulate GI motility (eg, stool softeners, laxatives, or fiber supplements) taken currently, or within 7 days. Antacid (histamine 2 blockers and proton pump inhibitors) and antidiarrheal agents are not prohibited • History of GI surgery (6 months prior to randomization), including but not limited to bariatric surgery and bowel resection, or history of, or active GI disease(s) that may affect assessment of tolerability, including but not limited to inflammatory bowel disease, irritable bowel syndrome, autoimmune disease, or GI malignancy • Participation in an interventional clinical trial or use of any investigational agent within 30 days before randomization • Clinically significant or uncontrolled concomitant medical condition that would put the patient at risk or jeopardize the objectives of the study in the opinion of the PI • In the opinion of the PI, patient unlikely for any reason to be able to comply with study procedures • Contraindications, sensitivities, or known allergy to the use of the study product or its components INTERVENTION AND COMPARATOR: Patients will be randomized (1,1) to receive either SSC and KB109 or SSC alone. During SSC, patients should follow the steps as instructed by their healthcare provider to care for themselves and protect other people in the home and community from potentially contracting COVID-19. Management of COVID-19-related symptoms with over-the-counter cough, cold, and anti-pyretic medications by patients is permitted in accordance with the medications' respective drug facts label or as instructed by the patient's healthcare provider. Following randomization, patients assigned to receive KB109 and SSC will receive a Kaleido Biosciences, Inc at-home study kit including a thermometer, pulse oximeter, and KB109. During the Intake Period (days 1-14), KB109 will be reconstituted in water by the patient and consumed by the patient twice daily (at least 8 hours apart), following an up-titration dosing schedule: Days 1 to 2: 9 g twice daily for a total daily dose of 18 g Days 3 to 4: 18 g twice daily for a total daily dose of 36 g Days 5 to 14: 36 g twice daily for a total daily dose of 72 g During the intake period, patients will record their daily COVID-19-related symptoms, selected COVID-19 signs (as self-measured using the provided thermometer and pulse oximeter), responses to questions related to QOL measures, health care use measures, and concomitant medications taken in the previous 24 hours. Wellness visits by telephone will be conducted between days 1 and 14 to follow up on patient's health status and to ascertain compliance with KB109 and completion of questions. On day 14, all patients will undergo a telemedicine visit where the following will be conducted: abbreviated physical examination, assessment of safety and other protocol-specified measures of health, and an evaluation of whether follow-up treatment is recommended owing to a progression of COVID-19 symptoms. If feasible, blood samples for clinical chemistries, biomarkers and serological measure of immunity, and nasal/oropharyngeal swabs for quantitative viral load assessments will be collected. Beginning on day 15, patients in both groups will enter the follow-up period (days 15-35) where COVID-19 signs, symptoms, and health care use indices will be collected. Wellness visits by telephone will be conducted on days 21, 28, and 35 to follow-up on the patient's health status. On day 35, all patients will undergo a telemedicine visit where the same information as the day 14 telemedicine visit will be collected, including any blood samples. MAIN OUTCOMES The primary outcome for the K031 and K032 studies is to evaluate the safety of KB109 in addition to SSC compared with SSC alone in outpatients with mild to moderate COVID-19 by assessing the number of patients experiencing KB109-related treatment-emergent adverse events (TEAEs) during the study. K031 will also evaluate duration of symptoms among outpatients with mild to moderate COVID-19. This will be as an assessment made during the intake and/or follow-up periods of the following: • Time to resolution of the 13 overall and the 8 cardinal COVID-19-related symptoms from day 1 until the day at which the composite score of the 13 overall and 8 cardinal COVID-19-related symptoms becomes 0 or 1 and remains at 0 or 1 for the rest of the intake period and for the follow-up period • Proportion of patients with a reduction from baseline in each of the 13 overall COVID-19-related symptoms • Proportion of patients in whom symptoms (present at baseline) become absent for each of the 13 overall COVID-19-related symptoms • Change from baseline in the overall composite score of the 13 overall COVID-19-related symptoms and the 8 cardinal COVID-19-related symptoms • Time to resolution of fever (defined as from day 1 until the day at which a patient's daily maximum temperature achieves and remains below 100.4°F without antipyretic medication) • Proportion of patients with oxygen saturation <95% and <98% on days 14 and 35 • Measures collected from the health care provider wellness visits • Proportion of patients experiencing hospital admissions (all cause and COVID-19-related) • Health care use K032 will evaluate the effect of KB109 in addition to SSC compared with SSC alone on the gut microbiota structure and function in outpatients with mild to moderate COVID-19. Before days 1, 14, and 35, microbiota structure (eg, magnitude of change in gut microbiome structure, composition of gut microbiome) will be analysed by methods such as nucleic acid sequencing and gut microbiome function will be analysed via levels of stool inflammatory biomarkers (eg, lipocalin) and gut microbiome metabolites (eg, SCFA). The health of outpatients with mild to moderate COVID-19 will be evaluated during the intake and follow- up periods by: measures of QOL; measures collected from the healthcare provider wellness visits; the proportion of patients experiencing hospital admissions; health care use, the proportions of patients with oxygen saturation <95% and <98%, and the proportion of patients with temperature below 100.4 °F without an anti-pyretic medication. Potential exploratory outcome measures may include: changes from baseline (day 1) in laboratory measures, specific biomarkers of infection, serology, inflammation (eg, D-dimer, lipocalin, cytokines, IgM/IgG sero-conversion, and neutralization assays), and viral load in outpatients with mild to moderate COVID-19 in the presence and absence of KB109. RANDOMISATION All patients deemed eligible for the studies will be randomized in a 1:1 ratio to KB109 in addition to SSC or SSC alone group using an interactive response technology system. Randomization will be stratified by study site/center, age groups (≥18-<45 years, ≥45-<65 years, ≥65 years), and comorbidity status (yes, no). BLINDING (MASKING) These studies are open-label; therefore, no blinding is necessary. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) K031 will enroll approximately 350 to 400 (175-200 patients per group) whereas K032 will enroll approximately 50 patients (25 per group). STUDY STATUS K031 protocol version 4, December 9, 2020; recruitment started in August, 2020, and the study is estimated to be completed in March 2021. This study is active and enrollment was completed in January, 2021. K032 protocol version 2, June 30, 2020; recruitment is estimated to start in July, 2020. This study is recruiting and the study is estimated to be completed in March 2021. STUDY REGISTRATION K031 is registered with the US National Library of Medicine, Identifier NCT04414124 as of June 4, 2020. K032 is registered with the US National Library of Medicine, Identifier NCT04486482 as of July 24, 2020. FULL PROTOCOL The full protocols are attached as additional files (Additional files 1 and 2), accessible from the ClinicalTrials.gov website. In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocols. The study protocols have been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional files 3 and 4).
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, Department of Microbiology and Physiological Systems, Clinical Director of the Center for Microbiome Research, University of Massachusetts Medical School, UMass Memorial Medical Group, Worcester, MA, USA.
| | | | - Yan Zheng
- Kaleido Biosciences, Inc, Lexington, MA, USA
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Schrading WA, Trent SA, Paxton JH, Rodriguez RM, Swanson MB, Mohr NM, Talan DA, Bahamon M, Carlson JN, Chisolm‐Straker M, Driver B, Faine B, Galbraith J, Giordano PA, Haran JP, Higgins A, Hinson J, House S, Idris AH, Kean E, Krebs E, Kurz MC, Lee L, Liang SY, Lim SC, Moran G, Nandi U, Pathmarajah K, Perez Y, Rothman R, Shuck J, Slev P, Smithline HA, Souffront K, Steele M, St. Romain M, Stubbs A, Tiao J, Torres JR, Uribe L, Venkat A, Volturo G, Wallace K, Weber KD. Vaccination rates and acceptance of SARS-CoV-2 vaccination among U.S. emergency department health care personnel. Acad Emerg Med 2021; 28:455-458. [PMID: 33608937 PMCID: PMC8013804 DOI: 10.1111/acem.14236] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Walter A. Schrading
- Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - Stacy A. Trent
- Department of Emergency Medicine Denver Health Medical Center Denver Colorado USA
- Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
| | - James H. Paxton
- Department of Emergency Medicine Wayne State University Detroit Michigan USA
| | - Robert M. Rodriguez
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
| | - Morgan B. Swanson
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Nicholas M. Mohr
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - David A. Talan
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
- Olive View–UCLA Education and Research Institute Los Angeles California USA
- Department of Emergency Medicine University of California‐Los Angeles Los Angeles California USA
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Neylan TC, Kessler RC, Ressler KJ, Clifford G, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Germine LT, Sheikh S, Storrow AB, Punches BE, Mohiuddin K, Gentile NT, McGrath ME, van Rooij SJH, Haran JP, Peak DA, Domeier RM, Pearson C, Sanchez LD, Rathlev NK, Peacock WF, Bruce SE, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Hwang I, Petukhova MV, Sampson NA, Koenen KC, McLean SA. Prior sleep problems and adverse post-traumatic neuropsychiatric sequelae of motor vehicle collision in the AURORA study. Sleep 2021; 44:zsaa200. [PMID: 32975289 PMCID: PMC7953217 DOI: 10.1093/sleep/zsaa200] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/16/2020] [Indexed: 01/11/2023] Open
Abstract
STUDY OBJECTIVES Many patients in Emergency Departments (EDs) after motor vehicle collisions (MVCs) develop post-traumatic stress disorder (PTSD) or major depressive episode (MDE). This report from the AURORA study focuses on associations of pre-MVC sleep problems with these outcomes 8 weeks after MVC mediated through peritraumatic distress and dissociation and 2-week outcomes. METHODS A total of 666 AURORA patients completed self-report assessments in the ED and at 2 and 8 weeks after MVC. Peritraumatic distress, peritraumatic dissociation, and pre-MVC sleep characteristics (insomnia, nightmares, daytime sleepiness, and sleep duration in the 30 days before the MVC, trait sleep stress reactivity) were assessed retrospectively in the ED. The survey assessed acute stress disorder (ASD) and MDE at 2 weeks and at 8 weeks assessed PTSD and MDE (past 30 days). Control variables included demographics, MVC characteristics, and retrospective reports about PTSD and MDE in the 30 days before the MVC. RESULTS Prevalence estimates were 41.0% for 2-week ASD, 42.0% for 8-week PTSD, 30.5% for 2-week MDE, and 27.2% for 8-week MDE. Pre-MVC nightmares and sleep stress reactivity predicted 8-week PTSD (mediated through 2-week ASD) and MDE (mediated through the transition between 2-week and 8-week MDE). Pre-MVC insomnia predicted 8-week PTSD (mediated through 2-week ASD). Estimates of population attributable risk suggest that blocking effects of sleep disturbance might reduce prevalence of 8-week PTSD and MDE by as much as one-third. CONCLUSIONS Targeting disturbed sleep in the immediate aftermath of MVC might be one effective way of reducing MVC-related PTSD and MDE.
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Affiliation(s)
- Thomas C Neylan
- San Francisco VA Healthcare System, San Francisco, CA
- Department of Psychiatry, University of California, San Francisco, CA
- Department of Neurology, University of California, San Francisco, CA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
| | - Gari Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Francesca L Beaudoin
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI
- Department of Emergency Medicine, The Miriam Hospital, Providence, RI
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA
- The Many Brains Project, Acton, MA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Emergency Medicine, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Kamran Mohiuddin
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI
| | - Claire Pearson
- Wayne State University Department of Emergency Medicine, Ascension St. John Hospital, Detroit, MI
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - William F Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO
- Department of Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO
| | | | - John F Sheridan
- Department of Neuroscience, Ohio State University Wexner Medical Center, Columbus, OH
- College of Dentistry Division of Bioscience, Ohio State University, Columbus, OH
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Maria V Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Haran JP, McCormick BA. Aging, Frailty, and the Microbiome-How Dysbiosis Influences Human Aging and Disease. Gastroenterology 2021; 160:507-523. [PMID: 33307030 PMCID: PMC7856216 DOI: 10.1053/j.gastro.2020.09.060] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
The human gut microbiome is a collection of bacteria, protozoa, fungi, and viruses that coexist in our bodies and are essential in protective, metabolic, and physiologic functions of human health. Gut dysbiosis has traditionally been linked to increased risk of infection, but imbalances within the intestinal microbial community structure that correlate with untoward inflammatory responses are increasingly recognized as being involved in disease processes that affect many organ systems in the body. Furthermore, it is becoming more apparent that the connection between gut dysbiosis and age-related diseases may lie in how the gut microbiome communicates with both the intestinal mucosa and the systemic immune system, given that these networks have a common interconnection to frailty. We therefore discuss recent advances in our understanding of the important role the microbiome plays in aging and how this knowledge opens the door for potential novel therapeutics aimed at shaping a less dysbiotic microbiome to prevent or treat age-related diseases.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine; Department of Microbiology and Physiological Systems; Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Beth A McCormick
- Department of Microbiology and Physiological Systems; Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts
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Liu W, Haran JP, Ash AS, Allison JJ, Ye S, Tjia J, Bucci V, Zhang B. High-dimensional Causal Mediation Analysis with a Large Number of Mediators Clumping at Zero to Assess the Contribution of the Microbiome to the Risk of Bacterial Pathogen Colonization in Older Adults. Curr Bioinform 2020. [DOI: 10.2174/1574893614666191115123219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Causal mediation analysis is conducted in biomedical research with the
goal of investigating causal mechanisms that consist of both direct causal pathways between the
treatment and outcome variables and intermediate causal pathways through mediators. Recently,
this type of analysis has been applied in the context of bioinformatics; however, it encounters the
obstacle of high-dimensional and semi-continuous mediators with clumping at zero.
Methods:
In this article, we develop a methodology to conduct high-dimensional causal mediation
analysis with a modeling framework that involves (i) a nonlinear model for the outcome variable,
(ii) two-part models for semi-continuous mediators with clumping at zero, and (iii) sophisticated
variable-selection techniques using machine learning. We conducted simulations and investigated
the performance of the proposed method. It is shown that the proposed method can provide reliable
statistical information on the causal effects with high-dimensional mediators. The method is
adopted to assess the contribution of the intestinal microbiome to the risk of bacterial pathogen
colonization in older adults from US nursing homes.
Conclusions:
The proposed high-dimensional causal mediation analysis with nonlinear models is
an innovative and reliable approach to conduct causal inference with high-dimensional mediators.
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Affiliation(s)
- Wei Liu
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Jeroan J. Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Shangyuan Ye
- Department of Population Medicine, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA, United States
| | - Jenifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Vanni Bucci
- Department of Biology, University of Massachusetts at Dartmouth, North Dartmouth, MA 01605, United States
| | - Bo Zhang
- Biostatistics and Research Design Center and Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, United States
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Schell BR, Ward DV, Bradley ES, Dutta P, Haran JP. ANTIBIOTIC EXPOSURE IN LONG-TERM CARE FACILITIES IS ASSOCIATED WITH URINARY MICROBIOME PERTURBATIONS. Innov Aging 2019. [PMCID: PMC6844949 DOI: 10.1093/geroni/igz038.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The discovery of the human urinary microbiome, defined as the microbial communities which colonize the human urinary tract, has shed new light on the meaning and clinical significance of bacteriuria. The prevalence of asymptomatic bacteriuria has been reported to be as high as 50% in healthy older adults living in long term care facilities, yet the urinary microbiome of this population has not been reported. The aim of this pilot study was to describe the urinary microbiome of this population and explore the cross-sectional relationship with recent antibiotic exposure. Voided urine samples were obtained from healthy, institutionalized older adults (ages 79 to 95), including non-catheterized men and women without any urinary symptoms. The bacterial genomic content of each urine sample was assessed by 16S rRNA sequencing. Among the 77 genera found across 16 urine samples, there was no significant difference in the microbial diversity across age groups. When grouped by antibiotic exposure, those recently exposed had a significantly lower diversity (Shannon’s index of 2.16 vs. 2.61, p = 0.029), and lower evenness (Pielou’s evenness of 0.58 vs. 0.69, p= 0.017) relative to those who were not recently exposed. Enrichment analysis showed that recent antibiotic exposure was associated with an increased abundance of the genus Bacteroides and decreased abundance of the genus Streptococcus. To our knowledge, this is the first report describing the urinary microbiome of institutionalized older adults and suggests that recent antibiotic exposure should be accounted for in future studies of the urinary microbiome in this population.
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Affiliation(s)
- Brent R Schell
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Doyle V Ward
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Evan S Bradley
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Protiva Dutta
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - John P Haran
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
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Bradley ES, Howe E, Wu X, Haran JP. Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment. Gut Pathog 2019; 11:29. [PMID: 31210787 PMCID: PMC6563367 DOI: 10.1186/s13099-019-0309-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/29/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is a reported association between proton pump inhibitor (PPI) exposure and increased risk of Clostridium difficile infection (CDI), but less is known about how this class of medications taken during treatment might influence mortality after CDI. Here we examine 180-day mortality rates in a cohort of CDI elders and its association with exposure to PPIs. We conducted a retrospective cohort study of elderly patients (> 65 years of age) diagnosed and treated for CDI in the years 2014–2016 (n = 874) in the Umass Memorial Health Care system, which represents both academic and community healthcare. Patient characteristics and medication use was extracted from the electronic medical record (EMR) and 6 month mortality data was obtained via the Center for Disease Control National Death Index. A Cox proportional hazards model was used to estimate hazard ratios associated with medication exposures and other relevant variables. Results Of the 874 elderly adults treated for CDI, 180-day all-cause mortality was 12.4%. Exposure to a PPI was associated with a 55% reduced risk of mortality (adjusted hazard ratio (aHR) 0.45; 95% confidence interval (CI) 0.28–0.72). In our Cox model, increasing age (aHR 1.45; 95% CI 1.14–1.84), those with severe CDI infections (aHR 1.87; 95% CI 1.22–2.88), and those with hospital acquired CDI (aHR 3.01; 95% CI 1.81–4.99) also had increased 180 day mortality risk. There were similar associations noted with both 90 day and 1-year mortality. Conclusion Use of PPIs during CDI treatment in elderly patients is associated with decreased 180-day mortality. Although use of PPIs has been associated with an increased risk of CDI, it appears to be protective against mortality when used during the treatment phase.
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Affiliation(s)
- Evan Stuart Bradley
- Department of Emergency Medicine, University of Massachusetts Medical School and Umass Memorial Medical Center, 55 North Lake Avenue, Worcester, MA 01605 USA
| | - Emily Howe
- 2University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 01605 USA
| | - Xun Wu
- 2University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 01605 USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School and Umass Memorial Medical Center, 55 North Lake Avenue, Worcester, MA 01605 USA
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Haran JP, Volturo GA. Macrolide Resistance in Cases of Community-Acquired Bacterial Pneumonia in the Emergency Department. J Emerg Med 2018; 55:347-353. [DOI: 10.1016/j.jemermed.2018.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/11/2018] [Indexed: 11/17/2022]
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Haran JP, Bucci V, Dutta P, Ward D, McCormick B. The nursing home elder microbiome stability and associations with age, frailty, nutrition and physical location. J Med Microbiol 2017; 67:40-51. [PMID: 29134939 DOI: 10.1099/jmm.0.000640] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The microbiome from nursing home (NH) residents is marked by a loss in diversity that is associated with increased frailty. Our objective was to explore the associations of NH environment, frailty, nutritional status and residents' age to microbiome composition and potential metabolic function. METHODOLOGY We conducted a prospective longitudinal cohort study of 23 residents, 65 years or older, from one NH that had four floors: two separate medical intensive floors and two floors with active elders. Residents were assessed using the mini nutritional assessment tool and clinical frailty scale. Bacterial composition and metabolic potential of residents' stool samples was determined by metagenomic sequencing. We performed traditional unsupervised correspondence analysis and linear mixed effect modelling regression to assess the bacteria and functional pathways significantly affected by these covariates.Results/Key findings. NH resident microbiomes demonstrated temporal stability (PERMANOVA P=0.001) and differing dysbiotic associations with increasing age, frailty and malnutrition scores. As residents aged, the abundance of microbiota-encoded genes and pathways related to essential amino acid, nitrogenous base and vitamin B production declined. With increasing frailty, residents had lower abundances of butyrate-producing organisms, which are associated with increased health and higher abundances of known dysbiotic species. As residents became malnourished, butyrate-producing organisms declined and dysbiotic bacterial species increased. Finally, the microbiome of residents living in proximity shared similar species and, as demonstrated for Escherichia coli, similar strains. CONCLUSION These findings support the conclusion that a signature 'NH' microbiota may exist that is affected by the residents' age, frailty, nutritional status and physical location.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vanni Bucci
- Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Biology, University of Massachusetts Dartmouth, Dartmouth, MA, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Doyle Ward
- Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Beth McCormick
- Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
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Haran JP, Bradley E, Howe E, Wu X, Tjia J. Medication Exposure and Risk of Recurrent Clostridium difficile
Infection in Community-Dwelling Older People and Nursing Home Residents. J Am Geriatr Soc 2017; 66:333-338. [DOI: 10.1111/jgs.15176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- John P. Haran
- Department of Emergency Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Evan Bradley
- Department of Emergency Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Emily Howe
- Department of Emergency Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Xun Wu
- Department of Internal Medicine; Tufts Medical School; Boston Massachusetts
| | - Jennifer Tjia
- Department of Quantitative Health Sciences; University of Massachusetts Medical School; Worcester Massachusetts
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Haran JP, Wilsterman E, Zeoli T, Beaudoin FL, Tjia J, Hibberd PL. Elderly patients are at increased risk for treatment failure in outpatient management of purulent skin infections. Am J Emerg Med 2016; 35:249-254. [PMID: 27836315 DOI: 10.1016/j.ajem.2016.10.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Current Infectious Disease Society of America (IDSA) guidelines for the management of purulent skin or soft tissue infections do not account for patient age in treatment recommendations. The study objective was to determine if age was associated with outpatient treatment failure for purulent skin infection after adjusting for IDSA treatment guidelines. METHODS We conducted a multicenter retrospective study of adult patients treated for a purulent skin infection and discharged home from four emergency departments between April and September 2014. Patients were followed for one month to assess for treatment failure (defined as need for a change in antibiotics, surgical intervention, or hospitalization). We used multivariable logistic regression to examine the role of patient age on treatment failure adjusting for demographic variables (gender, race), comorbidities and severity of infection. RESULTS A total of 467 patients met inclusion criteria (mean age 37.9years [SD 14.0], 48.2% of whom were women). Overall, 12.4% failed initial therapy. Patients 65years and older (n=35) were almost 4 times more likely to fail initial ED therapy in follow-up compared with younger patients (adjusted Odds Ratio (OR) 3.87, 95% Confidence Interval (CI) 1.24-12.10). After adjustment, for every 10years of advancing age there was a 43% increased odds of failing initial treatment (OR 1.43 95% CI 1.09-1.88). CONCLUSION Elderly patients with purulent skin infections, whose providers followed the 2014 IDSA guidelines, were more likely to fail initial treatment than younger patients. This study suggests that there is a need to re-evaluate treatment guidelines in elderly patients.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Eric Wilsterman
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tyler Zeoli
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Francesca L Beaudoin
- Department of Emergency Medicine, Alpert School of Medicine, Brown University, Providence, RI, United States
| | - Jennifer Tjia
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Patricia L Hibberd
- Department of Pediatrics and Division of Global Health, Massachusetts General Hospital, Boston, MA, United States
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Haran JP, Wu G, Bucci V, Fischer A, Boyer EW, Hibberd PL. Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice. Am J Emerg Med 2015; 33:1780-5. [PMID: 26381681 DOI: 10.1016/j.ajem.2015.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/16/2015] [Accepted: 08/17/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The Infectious Disease Society of America (IDSA) publishes evidence-based guidelines for the treatment of skin and soft tissue infections. How closely physicians follow these guidelines is unknown, particularly in the emergency department observation unit (EDOU) where increasing numbers of patients are treatment for these infections. Our objectives were to describe (1) the antibiotic treatment patterns EDOU patients, (2) physicians' adherence to the IDSA guidelines, and (3) factors that influence physician's prescribing practices. METHODS This prospective cohort enrolled adult patients discharged from an EDOU at an academic medical center after treatment for a skin or soft tissue infection. Information was collected from chart review and patient interview pertaining to the patient's sociodemographic characteristics, presenting illness, and antibiotic treatment regimens. Treatment regimens were compared with national guidelines. RESULTS The study included 193 patients of which only 43% were treated according to IDSA guidelines, 42% were overtreated, and 15% were undertreated. Women were more likely to be undertreated (relative risk, 1.58; 95% confidence interval, 1.21-2.06), whereas patients 50 years and older were at risk for overtreatment (relative risk, 1.44; 95% confidence interval, 1.03-2.02). Women also received shorter courses of antibiotic therapy with an average of 9.6 days of treatment compared with 10.6 days for men. CONCLUSIONS Physician antibiotic prescribing practices demonstrated poor adherence to IDSA guidelines and were influenced by the patient's age and sex. Standardized antibiotic protocols for treatment of skin and soft tissue infections to IDSA guidelines in the EDOU would minimize physician bias.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
| | - Gregory Wu
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Vanni Bucci
- Department of Biology, University of Massachusetts Dartmouth, North Dartmouth, MA
| | - Andrew Fischer
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Edward W Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Patricia L Hibberd
- Department of Pediatrics and Division of Global Health, Massachusetts General Hospital, Boston, MA
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Haran JP, Pezzella L. A case of neck pain: The presentation of Chairi 1 malformations in children. J Emerg Trauma Shock 2014; 7:32-4. [PMID: 24550627 PMCID: PMC3912648 DOI: 10.4103/0974-2700.125636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/04/2013] [Indexed: 11/28/2022] Open
Abstract
Chiari 1 malformations (CIM) in children can develop into a debilitating disease, however, they usually present with apparently benign symptoms, such as moderate headache and neck pain. Early identification and treatment of this condition can lead to an overall decrease in morbidity and mortality associated with this disease. We are reporting on a child that initially presented with neck pain and no neurological findings.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Lina Pezzella
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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